Medicare Part D
What the New Medicare Part D Rules Mean in Massillon
MASSILLON, Ohio — If you take prescription drugs and have Medicare, the yearly out-of-pocket limit on Part D is changing again for 2027. Here's a plain-English walk-through of how Part D works now, what the new numbers mean, and where to get help in Stark County.
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Part D plans rewrite their drug lists every year — tiers move, pharmacies change, drugs drop off. One call checks your exact medications against the 2027 plans in your area.
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Key takeaways
- The Part D out-of-pocket cap on covered prescriptions is $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay $0 for the rest of the year.
- The old "donut hole" coverage gap is gone as of 2025, leaving Part D with three simpler phases: deductible, initial coverage, and catastrophic.
- The maximum deductible any Part D plan can charge is $615 in 2026 and $700 in 2027. Only what you pay at the pharmacy (not your monthly premium) counts toward the yearly cap.
- A free, optional Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs into monthly payments across the year instead of paying it all at once, though the total amount you owe stays the same.
The big change: a $2,100 out-of-pocket cap
In 2027, no one with a Medicare Part D drug plan will pay more than $2,400 out of pocket for covered prescriptions in a calendar year. (The cap is $2,100 in 2026.) Once you hit that ceiling, you pay $0 for the rest of the year on covered drugs.
This cap replaced the old "donut hole" coverage gap, which went away in 2025. That means Part D now has three phases instead of four — simpler, and with a clear finish line.
Source: CMS — Medicare Part D program rules (medicare.gov).
The three phases of Part D in 2027
Here is how a year on a Part D plan flows:
1. The deductible phase. If your plan has a deductible, you pay the full negotiated price of your drugs until you meet it. The maximum deductible any Part D plan can charge is $700 in 2027 (it is $615 in 2026). Some plans set it lower, and some drugs may be covered before the deductible is met.
2. The initial coverage phase. After the deductible, you pay a copay or a share of the cost (coinsurance) for each prescription. Your plan pays the rest. You stay in this phase until your out-of-pocket spending reaches the yearly cap ($2,400 in 2027).
3. The catastrophic phase. Once your out-of-pocket total hits the yearly cap ($2,400 in 2027), you pay nothing for covered drugs for the rest of the year.
That's it — no more donut hole, no more confusing gap in the middle.
What counts toward the yearly cap
Only certain spending counts toward the cap. That includes what you pay for your covered Part D drugs at the pharmacy — your deductible, copays, and coinsurance. Your monthly Part D premium does not count toward the yearly cap.
If you get Extra Help (the low-income subsidy), you already pay much less, and the cap works alongside that program.
The Medicare Prescription Payment Plan
Even with a yearly ceiling, a big pharmacy bill in January can sting. That's where the Medicare Prescription Payment Plan comes in. It's a free option that lets you spread your out-of-pocket drug costs across the calendar year in monthly payments, instead of paying it all at the counter.
You don't save money overall — you pay the same total — but it can smooth out a rough month. Every Part D plan must offer it. You have to opt in; ask your plan how.
A note on higher-income enrollees (IRMAA)
Most people pay only their plan's Part D premium. But if your income is above $109,000 as a single filer (or $218,000 married filing jointly) based on your 2024 tax return, you may pay an extra amount called IRMAA on top of your Part D premium. Social Security will notify you if it applies.
What Massillon readers should know locally
Massillon sits in Stark County, where Medicare plan availability — including stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage — is set at the county level. The number of plans, the formularies (drug lists), and the pharmacy networks vary. The 2027 lineup is spelled out in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder. The program-level rules above (the yearly cap, the maximum deductible, the three phases) apply to every Part D plan nationwide.
Key dates to circle
- October 15 – December 7, 2026: Medicare Annual Enrollment Period. You can join, switch, or drop a Part D or Medicare Advantage plan. Changes take effect January 1, 2027.
- January 1 – March 31, 2027: Medicare Advantage Open Enrollment. If you're already in a Medicare Advantage plan, you get one chance to switch to another Advantage plan or return to Original Medicare with a stand-alone Part D plan.
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 Stark County
(MA penetration in Stark 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 hard 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
Q: I never hit the old donut hole. Does the yearly cap still help me?
Q: Does my monthly premium count toward the yearly cap?
Q: What if I can't afford my January refill?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.