Medicare Part D

Irmo SC Medicare Part D: 2027 Out-of-Pocket Cap

IRMO, S.C. — If you take prescription drugs and have Medicare, 2027 brings a Part D structure that's simpler than it used to be. The old "donut hole" is gone, there's a firm ceiling on what you'll pay out of pocket for covered drugs, and you have the option to spread those costs across the year instead of paying them all at once at the pharmacy counter.

Here's a plain-English guide to how Part D works, what the numbers mean for 2027, and where Irmo residents can get personal help.

The three phases of Part D in 2027

Part D used to have four phases, including the well-known coverage gap. As of 2025, that gap is gone. In 2027, your covered drug costs move through three phases:

1. Deductible phase. You pay the full negotiated price for your covered drugs until you meet your plan's deductible. The maximum deductible is $615 in 2026 and $700 in 2027, but plans can set it lower — some set it at zero. Once you've paid up to your deductible, you move to the next phase.

2. Initial coverage phase. You and your plan share the cost. You pay a copay or coinsurance for each prescription, and the plan pays the rest. This continues until your out-of-pocket spending on covered drugs reaches the annual cap.

3. Catastrophic phase. Once your out-of-pocket spending on covered drugs hits the annual cap — $2,100 in 2026 and $2,400 in 2027 — you pay nothing for the rest of the year for covered Part D drugs. That ceiling is new-generation Medicare — before 2024, there was no hard cap at all.

What counts toward the annual cap

The cap applies to what you pay out of pocket for drugs covered by your Part D plan — deductible payments, copays, and coinsurance. It does not include your monthly Part D premium. It also doesn't include drugs your plan doesn't cover, or drugs bought outside your plan's network without an exception.

If you get Extra Help (the low-income subsidy), your costs are already lower and you may not come close to the cap. If you take high-cost specialty drugs, you may hit it early in the year — and then owe nothing for covered drugs the rest of the year.

The Medicare Prescription Payment Plan

Even with a yearly ceiling, a big pharmacy bill in January can sting. That's why Medicare now offers the Medicare Prescription Payment Plan, sometimes called "M3P." It's optional and free to join.

Here's the idea: instead of paying the pharmacy directly when you fill a prescription, your Part D plan bills you monthly, spreading your yearly drug costs into predictable payments. You don't pay more overall — you just pay it in installments. To enroll, contact your Part D or Medicare Advantage drug plan directly and ask.

How this fits with the rest of Medicare

Part D is prescription drug coverage. You can get it in two ways: as a stand-alone drug plan added to Original Medicare, or built into a Medicare Advantage plan. Irmo is in Richland and Lexington counties, and both counties have a range of stand-alone Part D plans and Medicare Advantage plans with drug coverage. The 2027 lineup for your plan is in its Annual Notice of Change, and all available 2027 options appear on Medicare.gov's Plan Finder. Availability, formularies (the list of covered drugs), and pharmacy networks vary by plan and by county — which is why comparing on Medicare's Plan Finder is worth the time.

A note on higher incomes: if your modified adjusted gross income is above $109,000 as a single filer in 2026 (or above the joint-filer threshold), you'll pay an income-related monthly adjustment (IRMAA) on top of your Part D premium. Social Security will notify you if this applies.

Key dates to remember

• October 15 – December 7: Medicare Annual Enrollment Period. This is when most people can join, switch, or drop a Part D or Medicare Advantage plan for the following year.
• January 1 – March 31: Medicare Advantage Open Enrollment Period. If you're in a Medicare Advantage plan, you can make a one-time switch during this window.

Missing enrollment windows can mean waiting a full year — and, if you go without creditable drug coverage, a late enrollment penalty added to your premium later.