Medicare Part D
American Fork, UT: Part D 2027 cap & payment plan
American Fork, Utah — Starting January 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. The out-of-pocket cap continues to be the biggest change to Medicare drug coverage in years, and for households in American Fork managing a long medication list, it is worth understanding before the next refill.
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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 rises to $2,400 in 2027.
- The old "donut hole" coverage gap is gone; Part D now has just three payment phases.
- The Medicare Prescription Payment Plan lets you spread drug costs across monthly bills instead of paying big amounts at the pharmacy counter.
- Fall Open Enrollment runs October 15 through December 7, 2026 — the window to compare Part D options for 2027.
What the Part D cap actually means
Once your out-of-pocket spending on covered Part D drugs hits the annual cap — $2,100 in 2026, and $2,400 in 2027 — you pay nothing more for the rest of that calendar year on covered prescriptions. The counter resets each January.
The cap applies to what you spend on drugs your plan covers. It does not include your monthly Part D premium, and it does not apply to drugs your plan does not cover. Manufacturer discounts that flow through at the pharmacy do count toward your total, per CMS rules on medicare.gov.
The coverage gap is really gone
For many years, Part D had four phases, and the third was the confusing "donut hole" where costs jumped mid-year. That gap was fully eliminated in 2025 and remains gone in 2027.
Today, Part D has three phases:
1. Deductible phase. You pay full negotiated price until you meet your plan's deductible. In 2027, no Part D plan can set a deductible higher than $700. 2. Initial coverage phase. You pay a copay or coinsurance for each prescription, and your plan pays the rest. 3. Catastrophic phase. Once your out-of-pocket spending reaches the annual cap ($2,400 in 2027), you pay nothing more for covered drugs that year.
The monthly payment plan option
The Medicare Prescription Payment Plan is a newer feature that anyone with Part D can use — it is free to opt in, and it does not change what you owe overall. Instead, it spreads your yearly drug costs across monthly bills from your plan.
This can help if you have a high-cost prescription early in the year. Rather than paying, say, several hundred dollars at the pharmacy in January, your plan bills you a smoothed monthly amount. You still pay the same total for the year — you just do not front-load it.
You can request the payment plan through your Part D or Medicare Advantage drug plan. Medicare.gov has a fact sheet with the details and a sample calculator.
What American Fork residents should do this fall
American Fork is in Utah County, where residents can compare stand-alone Part D plans and Medicare Advantage plans that include drug coverage during Annual Enrollment, October 15 through December 7, 2026. Any choice you make takes effect January 1, 2027.
A few things worth checking on medicare.gov's Plan Finder before you decide:
- Whether your current prescriptions are on the plan's formulary for 2027.
- Whether your preferred American Fork or Utah County pharmacy is in the plan's network.
- Whether the plan's deductible, tier structure, and monthly premium fit your budget.
If your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your 2024 tax return, you may also owe an IRMAA surcharge on top of your Part D premium in 2026.
Where to get free, unbiased help
You do not have to sort this out alone. Utah's State Health Insurance Assistance Program (SHIP), often called Utah SHIP or the Senior Health Insurance Information Program, offers free one-on-one counseling. You can also call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week, or use the Plan Finder at medicare.gov.
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 Utah County
(MA penetration in Utah 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). There’s a hard yearly cap on what you pay out of pocket for covered drugs — $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 $2,100 cap include my monthly Part D premium?
What happens if I hit $2,100 in March?
Do I need to sign up for the Medicare Prescription Payment Plan?
Can I change my Part D plan for 2027?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.
Also for American Fork
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This page was last updated: October 7, 2026.