Medicare Part D

Why Medicare Part D Looks Different in Longview Next Year

LONGVIEW, Texas — Starting January 1, 2027, the way Medicare pays for prescription drugs continues to look different than it did before 2025. The yearly cap on what you personally pay out of pocket for covered Part D drugs rises to $2,400 in 2027. Once you hit that limit, you pay nothing more for covered prescriptions until the year resets.

For people in Longview who have watched drug prices creep up, this is one of the most meaningful changes to Medicare in a long time — and it's worth understanding before the Annual Enrollment Period closes on December 7.

The $2,100 cap, in plain English

Under the 2027 Part D rules, no one enrolled in a Medicare drug plan will pay more than $2,400 out of pocket for covered prescription drugs during the year. That's up from the $2,100 cap in 2026, and it applies whether your coverage is a stand-alone Part D plan or built into a Medicare Advantage plan with drug coverage.

A few things to know:

• The cap only counts money you actually spend on covered drugs — your deductible payments, copays, and coinsurance.
• Monthly premiums don't count toward the $2,100.
• Drugs your plan doesn't cover don't count either. This is one reason it's worth checking your plan's formulary each fall.

The Part D maximum deductible is $615 in 2026 and $700 in 2027, though individual plans can set a lower deductible.

The "donut hole" is gone

If you've been on Medicare for a while, you probably remember the coverage gap — the awkward middle phase where your out-of-pocket costs would suddenly jump after your plan and you had spent a certain amount together. It was confusing, and it caught a lot of people off guard.

That's over. As of 2025, Medicare Part D has just three phases:

1. Deductible phase — you pay the full negotiated price until you meet the deductible (up to $700 in 2027). 2. Initial coverage phase — you pay copays or coinsurance until your out-of-pocket total reaches $2,400. 3. Catastrophic phase — you pay nothing more for covered drugs the rest of the year.

No more donut hole. No more sticker shock in July because you crossed an invisible line.

The Medicare Prescription Payment Plan

Here's the part a lot of people miss. Even with a $2,100 cap, hitting that number early in the year can still hurt if you take an expensive medication in January and get hit with a big bill at the pharmacy counter.

The Medicare Prescription Payment Plan is a free, optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying it all at once at the pharmacy.

A few points worth knowing:

• You still owe the same total — this program doesn't lower your costs, it smooths them.
• You pay $0 at the pharmacy for covered drugs; your plan bills you monthly.
• You have to opt in. Your plan won't do it automatically.
• You can enroll before the year starts or at any point during the year.

For someone who takes one high-cost drug — say, a specialty medication that would push you toward the cap in a single fill — this can turn a $2,100 January bill into more manageable monthly payments.

What Longview readers should check this fall

Longview is in Gregg County, where Medicare beneficiaries choose among a range of stand-alone Part D and Medicare Advantage plans during the Annual Enrollment Period (October 15 – December 7). Availability is set at the county level, not the city level.

Because the drug benefit continues to evolve, plans have adjusted their premiums, formularies, and pharmacy networks for 2027. A few things worth doing:

• Read your Annual Notice of Change (ANOC). Your plan mailed it in September. It spells out what's different for 2027.
• Check the formulary. Make sure your prescriptions are still covered and at the same tier.
• Look at your preferred pharmacies. Some plans have preferred and non-preferred networks, and prices can differ.
• Compare on Medicare.gov's Plan Finder. It's the official tool and includes every plan in Gregg County.

If you miss the December 7 deadline, you still have the Medicare Advantage Open Enrollment Period (January 1 – March 31) to switch or drop an Advantage plan, but changes to stand-alone Part D plans are more limited after AEP closes.

A quick word on higher-income enrollees

If your income is above $109,000 as a single filer (or $218,000 for joint filers), based on your 2024 tax return, you'll pay an IRMAA surcharge on top of your standard Part D premium in 2026. This is separate from the $2,100 cap and doesn't affect how much you pay for the drugs themselves.