Medicare Part D
Medicare Part D in Sioux Falls, SD for 2027
SIOUX FALLS, S.D. — On Jan. 1, 2027, the hard yearly ceiling on what people with Medicare drug coverage can be asked to pay out of pocket for prescriptions rises to $2,400. The cap itself took effect in 2026 at $2,100, and it's a central feature to weigh as Sioux Falls residents finalize their choices during the Annual Enrollment Period, which runs through Dec. 7.
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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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Speak to a Licensed Insurance Agent
Click to call 855-729-3240Key takeaways
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once you reach it, covered drugs cost $0 for the rest of that calendar year.
- Part D now has three phases—deductible (up to $615 in 2026 ($700 in 2027)), initial coverage, and catastrophic—since the old "donut hole" coverage gap was eliminated in 2025.
- The Medicare Prescription Payment Plan (M3P) lets you spread drug costs across the year instead of paying a big bill early, and you sign up through your Part D or Medicare Advantage plan, not Medicare directly.
- People with 2024 income above $109,000 (single) or $218,000 (joint) may owe an IRMAA surcharge on premiums in 2026, though this doesn't change the $2,100 cap, and the Annual Enrollment Period to review plan choices runs through Dec. 7.
Here's a plain-English guide to what's changing, what stays the same, and how to think through your options.
The Part D cap, explained
The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once your out-of-pocket spending on covered prescription drugs reaches that year's cap, you pay $0 for covered drugs for the rest of the calendar year. This applies to everyone with Part D coverage — whether you get it through a stand-alone drug plan or bundled into a Medicare Advantage plan.
A few important details from Medicare:
- Only your out-of-pocket spending on covered drugs counts toward the cap.
- Monthly premiums do not count toward the $2,100 in 2026 ($2,400 in 2027).
- The Part D deductible in 2026 can be no more than $615, though many plans set it lower.
- The cap resets each January.
For people who take expensive brand-name or specialty medications, this is the change that matters most. Before 2024, there was no annual limit at all.
The coverage gap is gone
You may still hear the phrase "donut hole." It no longer applies.
Part D used to have four phases, including a middle "coverage gap" where you paid a bigger share of your drug costs. That gap was eliminated in 2025. Since then, Part D has just three phases:
1. Deductible phase — you pay full negotiated price until you meet the plan's deductible (up to $615 in 2026; up to $700 in 2027). 2. Initial coverage phase — you pay a copay or coinsurance until your out-of-pocket total reaches the yearly cap ($2,100 in 2026; $2,400 in 2027). 3. Catastrophic phase — you pay $0 for covered drugs the rest of the year.
That's it. No more confusing middle stage where costs suddenly jumped.
The Medicare Prescription Payment Plan
Even with the yearly cap, hitting a big pharmacy bill in January can sting. Medicare's answer is the Medicare Prescription Payment Plan, sometimes called "M3P."
Here's how it works:
- It's optional and free to join.
- Instead of paying the pharmacy at pickup, your drug plan bills you monthly.
- Your yearly total is the same — this program spreads it out, it doesn't reduce it.
- You can sign up before the plan year starts or any time during the year.
This tends to help most if you have a large drug cost early in the year. It tends to help less if your drug costs are low or spread evenly. You sign up through your Part D or Medicare Advantage drug plan, not through Medicare directly.
What Sioux Falls residents should check during AEP
Sioux Falls is in Minnehaha County, and like every county in the country, it has its own set of Part D and Medicare Advantage plans available for 2026. The new cap applies everywhere, but plan premiums, formularies (the list of covered drugs), pharmacy networks, and deductibles still vary plan by plan.
Before Dec. 7, it's worth taking 20 minutes to:
- Log in at Medicare.gov/plan-compare and enter your current prescriptions.
- Confirm each of your drugs is on the 2027 formulary of the plan you're considering.
- Check whether your regular Sioux Falls pharmacy is in the plan's preferred network.
- Note the plan's 2027 deductible and whether it applies to all drug tiers.
If you take no prescriptions today, you still generally need Part D coverage (or credible coverage from another source) to avoid a late-enrollment penalty later.
A quick word on higher incomes (IRMAA)
If your 2024 income was above $109,000 for a single filer (or $218,000 for a couple filing jointly), you'll pay an income-related surcharge on top of your Part B and Part D premiums in 2026. This is called IRMAA. It doesn't change your cap ($2,100 in 2026, $2,400 in 2027) — it only affects premiums. Social Security notifies you by mail if you're subject to it, and you can appeal if you've had a life change like retirement.
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 Minnehaha County
(MA penetration in Minnehaha 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 in 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
Do I have to do anything to get the $2,100 cap?
Does the $2,100 include what my plan pays?
If I join the payment plan, could I owe money after Dec. 31?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.