Medicare Part D

Part D out-of-pocket cap: Texarkana, TX 2027

TEXARKANA, Texas — Starting Jan. 1, 2027, no one with Medicare Part D will pay more than $2,400 out of pocket for covered prescription drugs in a calendar year. It's part of the biggest shift in how Medicare drug coverage works in years, and it lands right as Texarkana-area seniors are choosing coverage during the fall Annual Enrollment Period, which runs Oct. 15 through Dec. 7.

Here's what the new cap actually does, what happened to the old "donut hole," and how a new monthly payment option can help spread drug costs across the year.

What the Part D cap really means

Before 2025, Part D enrollees who took expensive medicines could spend many thousands of dollars a year at the pharmacy. That's no longer the case.

In 2027, once your out-of-pocket spending on covered Part D drugs reaches $2,400, you pay nothing for the rest of the calendar year on those drugs. The cap resets each January.

A few things worth knowing:

• The cap applies to covered drugs on your plan's formulary. Drugs your plan doesn't cover don't count toward it.
• Premiums do not count toward the cap.
• The cap applies whether your Part D coverage comes through a stand-alone drug plan or is built into a Medicare Advantage plan.
• The Part D maximum deductible is $615 in 2026 and $700 in 2027, though many plans set it lower.

These figures come directly from CMS, the federal agency that runs Medicare.

The "donut hole" is gone

For years, the coverage gap — the "donut hole" — was the confusing middle stretch where people suddenly paid more after their plan's initial coverage ran out. That phase was eliminated as of 2025.

Part D now has three straightforward phases:

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

No more surprise middle stage. No more math about when the gap starts or ends.

The Medicare Prescription Payment Plan

Even with a $2,100 in 2026 ($2,400 in 2027) ceiling, some people hit big bills early in the year — for example, a $900 charge in January for one specialty medication. That can be hard on a fixed income.

That's why Medicare now offers the Medicare Prescription Payment Plan, sometimes called "M3P" or drug cost smoothing. It's optional and free to join.

Here's the idea: instead of paying the pharmacy at pickup, you pay $0 at the counter. Your Part D plan bills you monthly for what you would have owed, spread across the remaining months of the year. Your total cost for the year doesn't change — the cap is still $2,100 in 2026 ($2,400 in 2027) — but the timing does.

Who tends to benefit:

• People with one or more high-cost drugs, especially early in the year.
• People whose out-of-pocket spending is likely to be uneven month to month.

Who may not need it:

• People whose drug costs are low or steady all year.

You can sign up before the plan year starts or at any point during the year by contacting your Part D plan. If you miss a monthly bill, you can be removed from the program, so it's important to keep up with payments.

What this looks like around Texarkana

Texarkana sits in Bowie County, and Medicare plan availability is set at the county level. That means every Part D and Medicare Advantage plan offered in Bowie County must follow the same 2027 federal rules described above: the $2,400 cap, the $700 maximum deductible, and access to the Medicare Prescription Payment Plan. The 2027 lineup is detailed in each plan's ANOC and on Medicare.gov's Plan Finder.

Plans differ in premiums, formularies (the list of covered drugs), pharmacy networks, and prior-authorization rules. Two plans can both follow the same federal caps and still handle your specific prescriptions very differently. That's why it's worth checking your drugs against a plan's formulary before you enroll — not just looking at the premium.

You can compare every plan available in Bowie County using the Plan Finder at medicare.gov.

How to decide during this enrollment window

A few practical steps for the Oct. 15–Dec. 7 window:

• Make a current drug list. Include dosages and how often you take each one.
• Check the formulary. Confirm your Part D or Medicare Advantage plan will still cover your drugs in 2027, and at what tier.
• Look at total cost, not just premium. Deductible, copays, and pharmacy choice all matter.
• Ask about the payment plan. If you take expensive medicines, decide whether monthly smoothing would help.
• Read your Annual Notice of Change. Your current plan mailed one in September; it lists what's changing for 2027.

If you miss the Dec. 7 deadline and you're in a Medicare Advantage plan, you still have the Medicare Advantage Open Enrollment Period from Jan. 1 to March 31 to switch Advantage plans or return to Original Medicare.

A quick note on higher-income enrollees

If your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your 2024 tax return, you may pay an income-related monthly adjustment amount, known as IRMAA, on top of your Part B and Part D premiums in 2026. Social Security notifies you if this applies. It doesn't change the cap ($2,100 in 2026, $2,400 in 2027) — just your monthly premium.