Medicare Part D
$2,100 Out-of-Pocket Cap: Medicare Part D in Morgantown
MORGANTOWN, W.Va. — If you take prescription drugs and have Medicare, 2027 is a year worth paying attention to. Part D — the part of Medicare that covers prescription drugs — has a hard limit on what you pay out of pocket each year, and the old "donut hole" is gone for good. Here's a plain-English walk-through of how it works, and the small mistakes that can trip people up.
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Key takeaways
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once you reach that amount on covered drugs in a calendar year, you pay $0 for covered drugs for the rest of that year, and the cap applies to every Part D plan.
- The old "donut hole" coverage gap is gone, so Part D now has just three phases: deductible, initial coverage, and catastrophic.
- The Medicare Prescription Payment Plan is a free, optional way to spread your drug costs into monthly payments instead of paying it all at once, but you must opt in and it doesn't lower your total costs.
- If your income is above certain limits, like $109,000 for single filers in 2026, you may owe an extra Part D charge called IRMAA, but you can ask for a reconsideration if your income has since dropped.
The big number: $2,100 out-of-pocket cap
The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once you reach that amount on covered prescription drugs in a calendar year, you pay $0 for the rest of the year on those covered drugs. The cap is set by Medicare and applies to every Part D plan, whether you get drug coverage through a stand-alone Part D plan or as part of a Medicare Advantage plan that includes drugs.
This is a real change for people on expensive medications. In past years, there was no upper limit. Now there is.
The three phases of Part D
Since the coverage gap ("donut hole") was eliminated in 2025, Part D has just three phases:
1. Deductible phase. You pay the full negotiated price for your drugs until you meet the plan's deductible. The maximum allowed deductible is $615 in 2026 and $700 in 2027, but plans can set theirs lower — some have no deductible at all. Check your plan's paperwork. 2. Initial coverage phase. After the deductible, you pay a copay or a percentage (coinsurance) for each prescription, and your plan pays the rest. This continues until your out-of-pocket spending reaches the annual cap. 3. Catastrophic phase. Once you hit the cap on covered drugs, you pay nothing more for covered drugs for the rest of the calendar year.
The counter resets every January 1.
The Medicare Prescription Payment Plan: smoothing the bill
Hitting $2,100 in January or February can still sting if it lands all at once. That is where the Medicare Prescription Payment Plan comes in. It is a free, optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly payments instead of paying at the pharmacy counter.
You still pay the same total — this does not lower your costs — but it can make a big January bill more manageable. You have to opt in through your plan; it does not happen automatically. You can sign up before the year starts or any month during the year.
What's available around Morgantown
Morgantown is in Monongalia County, where Medicare plan availability — including stand-alone Part D plans and Medicare Advantage plans with drug coverage — is set at the county level. That means two neighbors on opposite sides of a county line can have different plan menus.
To see what is offered in Monongalia County for 2027, use the Plan Finder at medicare.gov and enter your ZIP code. It will pull the current list for your address. Your current plan's 2027 details are also in its Annual Notice of Change.
IRMAA: a note for higher-income households
Most people pay only their Part D plan premium. But if your income is above certain thresholds, you also pay an Income-Related Monthly Adjustment Amount (IRMAA) on top. For 2026, IRMAA on Part D begins for single filers with income above $109,000 (higher thresholds apply for joint filers). Social Security uses your tax return from two years earlier to decide, and they'll send you a letter if it applies to you. If your income has dropped since then — retirement, loss of a spouse — you can ask for a reconsideration.
Mistakes to avoid this fall
A few common slip-ups cost people money or coverage:
- Skipping the Annual Notice of Change. Your plan mails one every fall. Read it. Formularies, tiers, and pharmacy networks can shift year to year.
- Assuming your drug is still covered. Plans update their drug lists (formularies) every January. A drug covered in 2026 may sit on a different tier — or not be covered — in 2027.
- Missing Open Enrollment. The Annual Enrollment Period runs October 15 through December 7. Changes made then take effect January 1. If you have a Medicare Advantage plan, you get a second window: Medicare Advantage Open Enrollment, January 1 – March 31.
- Delaying Part D when you first become eligible. If you go without creditable drug coverage for too long after you're first eligible, you can face a late enrollment penalty that sticks with you for as long as you have Part D.
- Forgetting Extra Help. If your income and resources are limited, the federal Extra Help program (also called the Low-Income Subsidy) can significantly reduce your Part D costs. You can apply through Social Security anytime.
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 Monongalia County
(MA penetration in Monongalia 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”) is eliminated as of 2025 (three phases now). There’s now a hard yearly cap of $2,100 in 2026 ($2,400 in 2027) on what you pay out of pocket for covered drugs, 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
Q: Does the $2,100 cap include my monthly premium?
Q: What happens if my drug isn't on the plan's list?
Q: Do I have to sign up for the Prescription Payment Plan every year?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.