Medicare Part D

Medicare Part D Changes for Morgantown, W.Va.

MORGANTOWN, W.Va. — Starting Jan. 1, 2027, Medicare Part D will limit what you pay out of pocket for covered prescription drugs to $2,400 for the year. Once you hit that number, you pay nothing more for covered medications for the rest of 2027. It's one of the biggest changes to Medicare drug coverage in years, and for people in Monongalia County who take costly prescriptions, it's worth understanding before the Annual Enrollment Period ends on Dec. 7.

Here's what changed, what stayed, and how to think it through.

The $2,100 cap, in plain English

Every Part D plan — whether it's a stand-alone drug plan or built into a Medicare Advantage plan — must cap your yearly out-of-pocket spending on covered prescription drugs. The cap is $2,100 in 2026 and $2,400 in 2027, and the number is set by Medicare, not by insurance companies.

The cap counts what you pay at the pharmacy counter for covered drugs: deductibles, copays, and coinsurance. It does not count your monthly premium, and it does not count drugs your plan doesn't cover.

Once you reach $2,100, you're in what Medicare calls the "catastrophic phase," and you owe $0 for the rest of the calendar year on covered prescriptions.

The "donut hole" is gone

For years, Medicare drug coverage had a confusing middle stage called the coverage gap — the "donut hole" — where your share of drug costs jumped after you hit a certain spending level, then dropped again once you spent enough to reach catastrophic coverage.

That gap was eliminated in 2025 and stays gone. Part D now has three phases instead of four:

1. Deductible phase — you pay full negotiated price until you meet your plan's deductible (no more than $615 in 2026; the maximum is $700 in 2027). 2. Initial coverage phase — you pay a copay or coinsurance for each prescription. 3. Catastrophic phase — once your out-of-pocket spending hits the yearly cap ($2,100 in 2026, $2,400 in 2027), you pay $0 for covered drugs the rest of the year.

That's it. No more donut hole math.

The Medicare Prescription Payment Plan

Hitting $2,100 in January is still a real strain if you take an expensive specialty drug. That's where the Medicare Prescription Payment Plan comes in.

This is a free, optional program — sometimes called "M3P" or drug cost "smoothing." Instead of paying a large amount at the pharmacy in a single month, you can spread your out-of-pocket drug costs across the remaining months of the calendar year in monthly bills from your plan.

A few things to know:

• You don't pay more overall. You pay the same total, just spread out.
• You still owe your monthly Part D premium separately.
• If you miss a monthly bill, you can be removed from the payment plan (but not from your drug coverage).
• You can opt in at any time during the year by contacting your Part D plan.

For someone facing a big upfront bill in January or February, it can make cash flow easier to manage. For someone whose drug costs are modest and spread out, it may not be necessary.

What this means during Annual Enrollment

The Annual Enrollment Period runs from Oct. 15 through Dec. 7. Any changes you make take effect Jan. 1, 2027.

Because every Part D plan now has to honor the same $2,100 cap and the same three-phase structure, the differences between plans come down to things like:

• Which drugs are on the plan's formulary (covered list),
• Which pharmacies are in network,
• The monthly premium,
• The deductible, and
• The copay or coinsurance tier for each of your specific medications.

Morgantown is in Monongalia County, where residents can choose from a range of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. The count changes each year, so it's worth checking medicare.gov for the current list rather than assuming last year's options still apply.

If you don't change anything, your current plan will generally auto-renew — but its formulary, premium, and pharmacy network can change. Read the Annual Notice of Change (ANOC) your plan mailed in September.

A note on higher-income beneficiaries

If your 2024 income was above $109,000 for a single filer (or $218,000 filing jointly), you may owe an Income-Related Monthly Adjustment Amount (IRMAA) on top of your standard Part B and Part D premiums in 2026. This is a separate calculation from the $2,100 cap and is handled by Social Security. If you get an IRMAA letter and your income has dropped since 2024 (retirement, loss of a spouse, etc.), you can ask for a reconsideration.