Medicare Part D

The 2027 Medicare Drug Cap for Mansfield, Ohio

MANSFIELD, Ohio — As Medicare's Annual Enrollment Period runs through Dec. 7, one change is drawing more questions than any other at kitchen tables across north-central Ohio: starting Jan. 1, 2027, what you pay out of pocket for prescription drugs under Medicare Part D will be capped at $2,400 for the year. Once you hit that ceiling, you pay nothing for covered drugs for the rest of the calendar year.

That's a meaningful shift from just a couple of years ago, when there was no hard limit at all. Here's what actually changed, and what it means as you look at your coverage for next year.

The Part D cap, in plain English

Under the rules set by the Inflation Reduction Act and administered by the Centers for Medicare & Medicaid Services (CMS), the annual out-of-pocket cap for Part D drugs is $2,100 in 2026 and $2,400 in 2027. The cap was $2,000 in 2025 and is indexed to rise slowly over time.

A few things to understand about the cap:

• It applies to what you pay out of pocket for covered prescription drugs — deductibles and copays or coinsurance at the pharmacy count toward it.
• Your monthly Part D premium does not count toward the cap.
• The cap resets every Jan. 1.
• It applies whether you get Part D through a stand-alone prescription drug plan or built into a Medicare Advantage plan with drug coverage.

The maximum Part D deductible any plan can charge is $615 in 2026 and $700 in 2027, as set by CMS. Plans can charge less, but not more.

The "donut hole" is really gone

For years, the coverage gap — the famous "donut hole" — was the part of Part D that tripped people up. You'd start the year with normal coverage, then suddenly hit a stretch where you paid a much larger share of your drug costs, then finally reach catastrophic coverage.

That middle stage was eliminated in 2025. Part D now has three phases:

1. Deductible phase — you pay full negotiated price until you meet your plan's deductible (up to $700 in 2027). 2. Initial coverage phase — you pay a copay or coinsurance; your plan pays the rest. 3. Catastrophic phase — once your out-of-pocket spending reaches $2,400 in 2027, you pay nothing for covered drugs the rest of the year.

For people who take expensive medications, hitting that catastrophic phase earlier in the year — and then paying nothing after — is the biggest practical change.

The Medicare Prescription Payment Plan

Here's the piece a lot of Mansfield-area readers ask about: even with the 2027 cap of $2,400, what if you can't front several hundred dollars at the pharmacy in January or February?

That's what the Medicare Prescription Payment Plan is for. It's a free, optional program offered through every Part D and Medicare Advantage drug plan. Instead of paying the pharmacy directly at pickup, you pay nothing at the counter for covered drugs, and your plan bills you monthly for what you would have owed — spread across the remaining months of the year.

A few points worth knowing:

• It doesn't lower your total drug costs. It just smooths them out.
• You can opt in at any time during the year by contacting your plan.
• It tends to help most if you have high drug costs early in the year, or predictable large refills.
• If you have very low drug costs, it may not be worth the paperwork.

What this means during Annual Enrollment

Mansfield is in Richland County, where — as in every county — plan availability is set by CMS and the private insurers that participate in Medicare. The Annual Enrollment Period (Oct. 15 – Dec. 7) is your window to:

• Join a Part D plan.
• Switch from one Part D plan to another.
• Switch between Original Medicare (with Part D) and Medicare Advantage.

If you're already on Medicare Advantage, you also get a second window, the Medicare Advantage Open Enrollment Period, Jan. 1 – March 31, to change Advantage plans or return to Original Medicare.

Because plans can change their formularies (the list of covered drugs), their pharmacy networks, and their tier pricing every year, it's worth checking that your current plan still covers your specific prescriptions for 2027 — even if you're happy with it today. The specifics of your current plan's 2027 changes appear in its Annual Notice of Change (ANOC), and the full 2027 lineup is on Medicare.gov's Plan Finder.

A quick word on higher-income enrollees

If your income is above $109,000 as a single filer (or the equivalent threshold for joint filers) based on your 2024 tax return, you may pay an income-related monthly adjustment amount (IRMAA) on top of your Part D premium in 2026. IRMAA is set by Social Security, not your plan, and it doesn't change the cap ($2,100 in 2026, $2,400 in 2027) — it just affects your premium.