Medicare Part D
Medicare Part D Changes in Lexington, SC 2027
LEXINGTON, S.C. — If you take prescription drugs and have Medicare, the yearly cap on what you pay out of pocket at the pharmacy is changing again for 2027. Here in Lexington, where many neighbors are weighing coverage during the fall enrollment window, understanding how Part D works can save you a lot of confusion at the counter.
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Will your prescriptions still be covered in 2027?
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.
- Every prescription checked, name by name
- Your pharmacy checked for preferred pricing
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Key takeaways
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once you reach the cap, the plan pays 100% of covered drugs for the rest of the calendar year.
- Before cost-sharing starts, people may need to meet a deductible. The maximum Part D deductible is $615 in 2026 and $700 in 2027.
- Part D now works in three phases—deductible, initial coverage, and catastrophic—since the old coverage gap was eliminated in 2025.
- A new optional program called the Medicare Prescription Payment Plan lets people spread drug costs into monthly payments over the year instead of paying it all at the pharmacy.
Below is a plain-language walk-through of the 2027 rules — the deductible, the out-of-pocket cap, and the three phases your drug costs move through during the year.
The out-of-pocket cap: $2,100 in 2026, $2,400 in 2027
In 2027, no one with a Medicare Part D plan will pay more than $2,400 out of pocket for covered prescription drugs in a calendar year (up from $2,100 in 2026). Once you hit that cap, your plan covers 100% of covered drugs for the rest of the year.
This cap applies whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan that includes drug coverage. It resets every January 1.
For a lot of people — especially anyone taking a high-cost specialty medication — this is one of the most important numbers to know for 2027.
The deductible: up to $700 in 2027
Before your plan starts sharing drug costs, you may need to meet a deductible. The maximum Part D deductible is $615 in 2026 and $700 in 2027.
A few things worth knowing:
- Plans can set their deductible anywhere from $0 up to the yearly maximum ($700 in 2027).
- Some plans apply the deductible only to certain drug tiers (often the more expensive ones).
- The deductible resets each year.
If you're comparing plans, the deductible amount — and which drugs it applies to — is one of the clearest apples-to-apples numbers you can look at.
The three phases of Part D in 2027
The old "donut hole" (coverage gap) was eliminated in 2025. That means Part D now has three phases instead of four:
1. Deductible phase. You pay the full negotiated price for your drugs until you've met your plan's deductible (up to $700 in 2027).
2. Initial coverage phase. After the deductible, you and your plan share the cost. You'll typically pay a copay or coinsurance for each prescription, based on the drug's tier.
3. Catastrophic phase. Once your out-of-pocket spending 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 confusing gap in the middle where costs suddenly jumped.
The Medicare Prescription Payment Plan
New for people worried about a big pharmacy bill early in the year: the Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across the calendar year in monthly payments instead of paying it all at the pharmacy counter.
It doesn't lower your total costs — you'll still owe the same amount over the year — but it can make a large January prescription easier to manage. Enrollment is optional and free, and you sign up through your drug plan.
What about higher-income enrollees?
If your income is above $109,000 (single filer, based on your 2024 tax return) or $218,000 for a couple filing jointly, you'll pay an income-related monthly adjustment amount, called IRMAA, on top of your Part D premium in 2026. Social Security notifies you if this applies.
Local context: Lexington County
Lexington is in Lexington County, where Medicare plan availability — including stand-alone Part D plans and Medicare Advantage plans with drug coverage — is set at the county level by the Centers for Medicare & Medicaid Services. That means two neighbors on the same street have the same menu of plan choices, even if their doctors and prescriptions are very different.
Because plan formularies (the list of covered drugs) and pharmacy networks vary, the smartest move each fall is to check that your specific medications are still covered the way you expect.
Key dates to remember
- Annual Enrollment Period: October 15 – December 7. This is when you can join, switch, or drop a Part D or Medicare Advantage plan for the following year.
- Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in a Medicare Advantage plan, you get one chance to switch.
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 Lexington County
(MA penetration in Lexington 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 yearly out-of-pocket cap include my monthly premium?
What happens if my drug isn't on my plan's formulary?
Do I have to sign up for the Prescription Payment Plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.