Medicare Part D
Rock Springs Medicare Part D Gets a $2,100 Yearly Cap
ROCK SPRINGS, Wyo. — Starting Jan. 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 cap was set at $2,100 for 2026 and rises to $2,400 for 2027. It lands right as the Annual Enrollment Period (Oct. 15 – Dec. 7) gives people a chance to review their coverage for the new year.
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Key takeaways
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027, after which covered drugs cost nothing more for the rest of the year.
- The old coverage gap, or "donut hole," was eliminated in 2025, leaving just three phases: deductible (up to $615 in 2026 and up to $700 in 2027), initial coverage, and catastrophic.
- The Medicare Prescription Payment Plan (M3P) lets people spread their out-of-pocket drug costs into monthly bills instead of paying it all at once, and you sign up through your Part D or Medicare Advantage plan, not Medicare itself.
- The Annual Enrollment Period runs Oct. 15 through Dec. 7, and any plan changes made then take effect Jan. 1, 2027. IRMAA surcharges affect premiums but not the drug cost cap.
Rock Springs seniors get a firm ceiling on drug costs in 2027
For readers in Rock Springs — and across Sweetwater County — the change matters most if you take expensive brand-name or specialty drugs. Once your out-of-pocket spending on covered prescriptions hits the yearly cap — $2,100 in 2026, $2,400 in 2027 — you pay nothing more for the rest of the year on those drugs.
The old "donut hole" is gone
If you've had Part D for a while, you remember the coverage gap, better known as the donut hole. It was the middle stretch where you suddenly paid a bigger share of your drug costs after early spending, and it confused a lot of people.
That gap was eliminated in 2025. Part D now has three simple phases:
1. Deductible phase — you pay full negotiated price until you meet your plan's deductible (up to a maximum of $615 in 2026). 2. Initial coverage phase — you pay a copay or coinsurance while your plan pays the rest. 3. Catastrophic phase — once your out-of-pocket costs reach $2,100, you pay nothing more for covered drugs the rest of the year.
That's it. No fourth phase, no gap in the middle.
The Medicare Prescription Payment Plan: spreading costs across the year
Hitting the cap is a relief, but paying the full annual amount in January isn't easy on a fixed income. That's why Medicare now offers the Medicare Prescription Payment Plan (sometimes called "M3P" or drug-cost smoothing).
Here's the idea: instead of paying the pharmacy in one lump when you fill a prescription, you can choose to spread your out-of-pocket drug costs across the remaining months of the calendar year in monthly bills from your Part D plan.
A few things to know:
- It's optional, and it's free to join — there's no fee or interest.
- Your total out-of-pocket cost for the year doesn't change; only the timing of what you pay does.
- You can opt in before the year starts or any time during the year.
- It tends to help most if you have high drug costs early in the year. If your prescriptions are inexpensive, it may not be worth the extra paperwork.
You sign up through your Part D or Medicare Advantage drug plan, not through Medicare directly.
What this means during Annual Enrollment
The Annual Enrollment Period runs Oct. 15 through Dec. 7 each year. Any Part D or Medicare Advantage change you make now takes effect Jan. 1, 2027.
A few things worth checking before Dec. 7:
- Your drug list (formulary). Plans update which drugs they cover every year.
- Your pharmacy network. Preferred pharmacies can change from year to year.
- Your Annual Notice of Change (ANOC). Your current plan mailed one in September; it spells out what's different for 2027.
- Whether the payment plan makes sense for you. If you know a costly refill is coming in January, this is the time to think it through.
Rock Springs is in Sweetwater County, and plan availability in Wyoming is set at the county level. A licensed agent, or your local SHIP counselor, can walk through which plans in Sweetwater County cover your specific medications.
A quick note on higher-income enrollees
If your income is above $109,000 as a single filer (or $218,000 for a couple) on your 2024 tax return, you'll pay an IRMAA surcharge on top of your standard Part B and Part D premiums in 2026. The $2,100 drug cap still applies — IRMAA affects your monthly premium, not your out-of-pocket drug cap.
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 Sweetwater County
(MA penetration in Sweetwater 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). The yearly out-of-pocket cap on covered drugs is $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 yearly cap include my monthly plan premium?
What if I take only generics? Will I ever hit the cap?
If I join the payment plan, do I still pay the pharmacy at pickup?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.