Medicare Part D

Coverage gap ends for Medicare Part D users in Bristol

BRISTOL, Va. — Starting Jan. 1, 2027, people with Medicare drug coverage will hit a firm ceiling on what they pay out of pocket for prescriptions: $2,400 for the year. Once you reach that amount, your Part D plan covers the rest of your covered drug costs for the calendar year. The cap, first introduced in 2025, is now in its third year, and the 2027 figure lands as the Annual Enrollment Period wraps up on Dec. 7.

What the $2,400 cap actually means in 2027

The cap is a hard annual limit on what you pay out of pocket for drugs covered by your Part D plan. That includes your deductible and any copays or coinsurance for covered prescriptions. Once your out-of-pocket spending on covered drugs reaches $2,400 in 2027, you pay nothing for those covered drugs the rest of the year.

A few details worth knowing:

• The cap applies whether you have a stand-alone Part D plan or drug coverage built into a Medicare Advantage plan.
• Monthly premiums do not count toward the $2,400 cap.
• Drugs that aren't on your plan's formulary don't count either — so the specific plan you choose still matters.
• The Part D deductible can be no higher than $615 in 2026, though many plans set it lower.

The coverage gap is officially history

For years, Medicare drug coverage had a confusing middle stage called the "donut hole," where costs jumped after you hit an initial spending threshold. That gap was eliminated in 2025.

Part D now has just three 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 copays or coinsurance until your out-of-pocket total reaches $2,400 in 2027. 3. Catastrophic phase — you pay nothing for covered drugs the rest of the year.

That's it. No more donut hole math.

The Medicare Prescription Payment Plan

Even with the $2,400 cap in 2027, hitting that ceiling early in the year can sting. If you fill an expensive prescription in January, you could owe hundreds at the pharmacy counter in a single month.

That's what the Medicare Prescription Payment Plan is for. It's a free, optional program that lets you spread your out-of-pocket drug costs across monthly bills from your plan instead of paying the pharmacy directly each time. You still pay the same total — the cap is $2,400 in 2027 — but the payments are smoothed out over the year.

A few things to know:

• You have to opt in. Your plan won't enroll you automatically.
• You can join before the year starts or at any point during the year.
• It tends to help most if you take a high-cost drug or expect to hit the cap.
• If you join mid-year, only costs from that point forward are spread out.

You can request it through your Part D plan directly.

What Bristol residents should check this fall

Bristol is in Bristol City, Virginia, where Medicare plan options are set at the county level. Both stand-alone Part D plans and Medicare Advantage plans with drug coverage are available in the area. Because plans can change formularies, pharmacy networks, and cost structures each year, the plan that worked in 2026 may not be the best fit in 2027. The 2027 lineup is detailed in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder.

During Annual Enrollment (Oct. 15 – Dec. 7), it's worth checking:

• Are all your current prescriptions still on the plan's formulary?
• Is your pharmacy still in the preferred network?
• Has the deductible or tier structure changed?

The plan finder at medicare.gov lets you enter your drugs and pharmacy to compare options for your ZIP code.

A quick note on higher incomes

If your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your 2024 tax return, you may owe an income-related surcharge called IRMAA on top of your Part B and Part D premiums in 2026. It doesn't change the $2,100 cap, but it can raise what you pay monthly.

Where to get help

For personalized answers, use official sources — not a sales call:

• Medicare.gov — plan finder, drug lookup, and enrollment.
• 1-800-MEDICARE (1-800-633-4227) — 24/7, free.
• Virginia Insurance Counseling and Assistance Program (VICAP) — the state's SHIP, offering free one-on-one counseling from trained volunteers.