Medicare Part D
What Part D's New $2,100 Drug Cap Means in 2026
CHILLICOTHE, Ohio — As the Medicare Annual Enrollment Period runs through Dec. 7, Part D's out-of-pocket cap is drawing questions at kitchen tables across Ross County. The cap was $2,100 in 2026 and rises to $2,400 in 2027 for covered prescription drugs in a calendar year.
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Key takeaways
- The Part D out-of-pocket cap on covered drugs is $2,100 in 2026 and $2,400 in 2027.
- The Part D deductible cannot be higher than $615 in 2026 or $700 in 2027, though plans may set it lower.
- The coverage gap ("donut hole") is gone — Part D now has just three payment phases.
- The Medicare Prescription Payment Plan lets you spread your drug costs into monthly bills instead of paying at the pharmacy counter.
That is a real shift from how Part D worked for two decades. The old "donut hole" is gone, the math is simpler, and there is now an option to spread your drug costs across the year in monthly payments. Here is what is actually changing, and what to do about it before the enrollment window closes.
The $2,100 cap, in plain English
The Part D out-of-pocket cap on covered prescriptions is $2,100 in 2026 and $2,400 in 2027. Once your spending on covered drugs reaches that amount, you pay nothing more for those drugs for the rest of the calendar year.
This cap applies to standalone Part D plans and to the drug coverage built into most Medicare Advantage plans. It does not apply to drugs your plan does not cover, or to Part B drugs (those are usually given in a doctor's office).
The cap resets every January.
Goodbye, donut hole
For years, Part D had four stages, and the confusing middle one was called the "coverage gap" or "donut hole." As of 2025, that stage was eliminated. Part D now has just three phases:
1. Deductible phase — You pay full negotiated price until you meet the plan's deductible. The maximum deductible is $615 in 2026 and $700 in 2027, and some plans set it lower or waive it for certain drugs. 2. Initial coverage phase — You pay a copay or coinsurance for each prescription. Your plan pays the rest. 3. Catastrophic phase — Once your out-of-pocket spending reaches the annual cap ($2,100 in 2026, $2,400 in 2027), you pay nothing more for covered drugs the rest of the year.
That is the whole picture. No middle stage where costs suddenly jumped.
The Medicare Prescription Payment Plan
One of the newer tools worth knowing about is the Medicare Prescription Payment Plan. It is optional, free to join, and available through your Part D plan.
Here is how it works: instead of paying a large amount at the pharmacy when you fill an expensive prescription, your plan bills you monthly for your share of drug costs. Your total for the year does not change — but the timing does. That can help if you take a high-cost medication in January and would rather not face the full bill at once.
You can sign up before the plan year starts or any time during the year. Ask your Part D plan directly, or call 1-800-MEDICARE for help getting started.
What Chillicothe residents should check during AEP
Chillicothe is in Ross County, where Part D plans and Medicare Advantage plans with drug coverage are set at the county level. During the Annual Enrollment Period (Oct. 15 – Dec. 7), you can:
- Switch from one Part D plan to another.
- Move between Original Medicare (with a standalone Part D plan) and Medicare Advantage.
- Drop or add drug coverage.
Even if you like your current plan, formularies (the list of covered drugs), pharmacy networks, and cost-sharing tiers can change from year to year. Your plan's Annual Notice of Change, mailed in September, spells out what is different for 2027. It is worth 15 minutes to read.
If you miss AEP, the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) gives Medicare Advantage members one more chance to switch plans or return to Original Medicare.
A quick word on higher-income enrollees
If your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your 2024 tax return, you may pay an IRMAA surcharge on top of your Part B and Part D premiums in 2026. Social Security will notify you if this applies. If your income has dropped due to a life event like retirement, you can request a review.
Where to get personalized help
Nothing above is a substitute for a one-on-one look at your prescriptions and your plan options. Free, unbiased help is available:
- Medicare.gov — Use the Plan Finder to compare Part D and Medicare Advantage options in Ross County using your actual drug list.
- 1-800-MEDICARE (1-800-633-4227) — Available 24/7.
- Ohio SHIP (OSHIIP) — Ohio's State Health Insurance Assistance Program offers free counseling. Call 1-800-686-1578.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Ross County
(MA penetration in Ross County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Prescription coverage
How Medicare Part D works in 2027
The old coverage gap (“donut hole”) was eliminated as of 2025 (three phases now). The yearly cap on what you pay out of pocket for covered drugs is $2,100 in 2026 and $2,400 in 2027, and you can spread those costs across the year with the Medicare Prescription Payment Plan.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
Good to know
Frequently asked questions
Does the $2,100 cap include my monthly Part D premium?
What happens if I take an expensive drug in January?
Do I have to sign up for anything new to get the $2,100 cap?
When can I change my Part D plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.
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This page was last updated: October 7, 2026.