Medicare Part D
How the Medicare drug payment plan works in Grants Pass
GRANTS PASS, Ore. — Since January 1, 2026, people with Medicare Part D drug coverage have had something they never had before: a firm, yearly limit on what they pay out of pocket for prescription drugs. That cap is $2,100 in 2026 and $2,400 in 2027, according to Medicare Part D program rules on medicare.gov.
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Click to call 855-729-3240Key takeaways
- The Medicare Part D out-of-pocket cap on covered prescription drugs is $2,100 in 2026 and rises to $2,400 in 2027.
- Once you hit the yearly cap — $2,100 in 2026, $2,400 in 2027 — you pay nothing more for covered drugs the rest of the year, and Part D has just three phases instead of the old "donut hole" gap.
- Medicare's Prescription Payment Plan lets you spread your drug costs into monthly bills across the year instead of paying it all at the pharmacy, and you can sign up before the year starts or anytime during it.
- The $2,100 cap and payment plan apply whether you have a stand-alone Part D plan or drug coverage through a Medicare Advantage plan, but higher earners may still pay an extra IRMAA amount on top of premiums, which does not affect the cap itself.
A big shift for Part D starts January 1
For many Grants Pass residents who take costly medications, this remains the biggest change to Medicare drug coverage in years. The fall Annual Enrollment Period (October 15 through December 7) is when people can review and switch drug or Medicare Advantage plans for 2027.
What the $2,100 cap actually means
The cap applies to what you personally pay for covered prescription drugs at the pharmacy in a calendar year. Once your out-of-pocket spending on covered drugs reaches the yearly limit — $2,100 in 2026, $2,400 in 2027 — you pay nothing more for those drugs for the rest of the year.
A few things worth knowing:
- The cap counts your deductible and copays or coinsurance on covered Part D drugs.
- It does not count your monthly plan premium.
- It resets each January.
- The maximum Part D deductible any plan can charge is $615 in 2026 and $700 in 2027, though many plans set theirs lower.
The "donut hole" is gone
For years, the coverage gap — the so-called "donut hole" — was one of the most confusing parts of Medicare. As of 2025, that middle phase went away. Part D now has just three phases: the deductible phase, the initial coverage phase, and catastrophic coverage, which kicks in once you hit the yearly cap ($2,100 in 2026, $2,400 in 2027).
That means no more falling into a stretch where your share suddenly jumps midyear. The path from your first prescription of the year to the cap is more predictable.
The Medicare Prescription Payment Plan
The yearly cap helps with the total, but hitting it in January still means paying that amount up front. To smooth that out, Medicare offers the Prescription Payment Plan, a free option that lets you spread your out-of-pocket drug costs across the calendar year in monthly bills instead of paying it all at the pharmacy counter.
A few points from medicare.gov:
- It is optional. You have to opt in through your Part D or Medicare Advantage drug plan.
- Your total yearly cost is the same — you are just paying the plan monthly instead of the pharmacy up front.
- It tends to help most if you have a high drug cost early in the year.
- If you rarely fill prescriptions or your drugs are inexpensive, it may not be worth the paperwork.
You can sign up before the plan year starts or at any point during the year.
What this looks like in Grants Pass
Grants Pass is in Josephine County, where Medicare beneficiaries can choose between Original Medicare with a stand-alone Part D drug plan or a Medicare Advantage plan that includes drug coverage. The $2,100 cap and the payment plan option apply to Part D drug coverage in both settings — whether your drug coverage comes through a stand-alone plan or is built into a Medicare Advantage plan.
Because plan formularies (the lists of covered drugs) and pharmacy networks change each year, this fall is a good time to log in to medicare.gov, enter your prescriptions, and see how your current plan will handle them in 2027. Your plan's Annual Notice of Change also spells out what's different next year.
Higher-income reminder: IRMAA
If your income is above certain levels, you pay an extra amount on top of your Part B and Part D premiums. For 2026, the Income-Related Monthly Adjustment Amount (IRMAA) starts above $109,000 for a single filer, based on your tax return from two years earlier. It does not affect the $2,100 cap, but it can affect your monthly costs, so it is worth checking.
Key dates to keep on the fridge
- October 15 – December 7, 2026: Medicare Annual Enrollment Period. Switch or join a Part D or Medicare Advantage plan for 2027.
- January 1, 2027: New $2,400 out-of-pocket cap takes effect (up from $2,100 in 2026).
- January 1 – March 31: Medicare Advantage Open Enrollment Period, for people already in a Medicare Advantage plan who want to switch or drop back to Original Medicare.
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 Josephine County
(MA penetration in Josephine 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
Does the $2,100 cap include my monthly premium?
If I sign up for the Prescription Payment Plan, do I still hit the $2,100 cap?
What if I only take a couple of low-cost generics?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.