Medicare Part D

$2,100 Part D out-of-pocket limit hits North Charleston in 2026

NORTH CHARLESTON, S.C. — Starting Jan. 1, 2026, no one with a Medicare Part D drug plan will pay more than $2,100 out of pocket for covered prescriptions in a calendar year. That's a $100 jump from the $2,000 cap that took effect in 2025, and it's part of the biggest overhaul of Medicare drug coverage in nearly two decades. For people in Charleston County who take expensive medications, the change could reshape how — and when — they pay at the pharmacy counter.

What the $2,100 cap actually covers

The cap applies to what you pay out of pocket for prescriptions covered by your Part D plan (or the drug portion of a Medicare Advantage plan). Once your covered spending hits the annual cap — $2,100 in 2026, rising to $2,400 in 2027 — you pay nothing more for the rest of the year on those covered drugs.

A few things the cap does not include: your monthly Part D premium, drugs your plan doesn't cover, and medications you fill outside your plan's pharmacy network. That's why checking your plan's formulary — the list of drugs it covers — still matters every fall.

The Part D maximum deductible is $615 in 2026 and $700 in 2027. Plans can charge less, but not more.

The coverage gap is officially gone

For years, Part D had a confusing "donut hole" phase where costs jumped in the middle of the year after you hit a spending threshold. That phase was eliminated in 2025 and remains gone in 2026 and 2027.

Part D now has three straightforward stages:

1. Deductible phase — you pay full negotiated price until you meet your plan's deductible (up to $615 in 2026 and $700 in 2027). 2. Initial coverage phase — you pay a copay or coinsurance while the plan pays the rest, until your out-of-pocket total reaches the annual cap ($2,100 in 2026, $2,400 in 2027). 3. Catastrophic phase — you pay nothing more for covered drugs the rest of the year.

That's it. No more donut hole math.

The Medicare Prescription Payment Plan: what it is, what it isn't

Even with the annual cap, hitting that number in January or February can hurt. That's where the Medicare Prescription Payment Plan comes in.

This is a free, optional program. Instead of paying the pharmacy the full copay when you pick up your medication, you pay $0 at the counter — and your plan bills you in monthly installments spread across the rest of the calendar year.

Important things to understand:

• It does not lower your total drug costs. It only spreads them out.
• You still owe the full amount over time. If you miss payments, you can be removed from the program.
• It's most useful for people with high drug costs early in the year. If your prescriptions are inexpensive, monthly billing may not help.
• You have to opt in. Contact your Part D plan or visit medicare.gov to enroll.

Medicare will also flag people who are likely to benefit, but you don't have to wait to be notified.

Mistakes to avoid this fall

North Charleston is in Charleston County, where Medicare beneficiaries have a range of stand-alone Part D and Medicare Advantage drug plans to compare during Open Enrollment. The 2027 lineup is detailed in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder. A few pitfalls to sidestep:

• Assuming your current plan is still your best fit. Formularies, pharmacy networks, and cost-sharing tiers change every year. Re-check.
• Confusing the cap with "free drugs." You still have a deductible and cost-sharing until you reach the annual out-of-pocket cap.
• Signing up for the payment plan without doing the math. Smoothing helps some people and hurts others. Ask your plan to walk through an estimate.
• Missing the deadlines. Annual Enrollment runs Oct. 15 – Dec. 7. Medicare Advantage Open Enrollment runs Jan. 1 – March 31 and only lets Advantage enrollees switch once.

A note on higher-income enrollees

If your income is above $109,000 as a single filer (or $218,000 filing jointly) in 2026, you may pay an Income-Related Monthly Adjustment Amount, or IRMAA, on top of your Part B and Part D premiums. IRMAA is based on your tax return from two years earlier. If your income has dropped since then — because of retirement, for example — you can ask Social Security to reconsider.