Medicare Part D

The end of the Part D coverage gap for Edmonds Medicare

EDMONDS, Wash. — Medicare's Part D prescription drug program now has a firm ceiling on what you pay out of pocket for covered drugs at the pharmacy. That ceiling was $2,100 in 2026, and starting January 1, 2027 it moves to $2,400 for the year. After you hit that number, you pay nothing more for the rest of 2027 on drugs covered by your plan.

That's a real shift, and it matters most to neighbors here in Edmonds who take expensive medications, or who have watched a loved one struggle to keep up with costs at Bartell's, Rite Aid, or the pharmacy counter at Swedish Edmonds.

Here's what's changing and how to think about it.

The $2,100 cap, in plain English

In 2025, Medicare put a cap on Part D out-of-pocket costs for the first time ($2,000). The cap was $2,100 in 2026, and for 2027 it moves to $2,400, adjusted under Medicare's usual annual formula.

What counts toward the cap:

• What you pay for covered prescription drugs under your Part D plan (or the drug portion of a Medicare Advantage plan that includes drugs).
• Deductibles, copays, and coinsurance for those drugs.

What does not count:

• Your monthly premiums.
• Drugs your plan doesn't cover.
• Over-the-counter medicines.

Once your out-of-pocket spending on covered drugs reaches $2,400 for the year, you're done paying for those drugs for the rest of 2027.

Goodbye, "donut hole"

If you've been on Medicare for a while, you know the phrase "coverage gap" — or the "donut hole." It was the confusing middle phase where your share of drug costs could jump for a stretch before catastrophic coverage kicked in.

That gap is gone. As of 2025, Part D has just three phases:

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

No more donut hole math. It's a cleaner structure, and it's the same across every Part D plan.

The Medicare Prescription Payment Plan

Here's a piece a lot of people miss: even with the $2,400 cap, you could still face a big bill in a single month — say, if a specialty medication costs $1,500 in January.

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 the calendar year in monthly payments, instead of paying the pharmacy in a lump sum.

A few things to know:

• You still owe the same total; the payment plan just smooths it out.
• You sign up through your Part D plan (not the pharmacy).
• It tends to help most if you have high drug costs early in the year.
• You can join anytime — you don't have to wait for open enrollment.

If you'd benefit from steadier monthly bills instead of a big January hit, ask your plan directly about enrolling.

What this means locally in Edmonds

Edmonds is in Snohomish County, and Part D and Medicare Advantage plan availability is set at the county level by the Centers for Medicare & Medicaid Services (CMS). That means the same menu of plans available to someone in Lynnwood or Mill Creek is available to you here.

The number of stand-alone Part D plans and Medicare Advantage plans offered in Snohomish County changes each year. For the 2027 lineup, check each plan's Annual Notice of Change and the Plan Finder tool at Medicare.gov using your ZIP code.

The cap, the deductible ceiling, and the payment plan option apply the same way in every county — they're federal rules, not local ones.

Higher-income? Watch IRMAA

If your income is above $109,000 as a single filer (or $218,000 filing jointly) in 2026, you'll pay an income-related surcharge, called IRMAA, on top of your Part D and Part B premiums. This is based on your tax return from two years earlier, so 2024 income drives 2026 surcharges. If your income has dropped since then — retirement, loss of a spouse, reduced work hours — you can appeal using Form SSA-44.

Key dates to circle

• Oct. 15 – Dec. 7, 2026: Medicare Annual Enrollment Period. This is when you can change your Part D or Medicare Advantage plan for 2027.
• Jan. 1, 2027: New benefits, including the $2,400 cap, take effect.
• Jan. 1 – March 31, 2027: Medicare Advantage Open Enrollment. If you're already in a Medicare Advantage plan, you get one chance to switch.

If you don't do anything during fall enrollment, your current plan generally rolls over — but plan details (formularies, pharmacy networks, copays) can change year to year. It's worth a look.