In short
- The yearly cap on covered Part D drug costs is $2,100 in 2026 and $2,400 in 2027.
- The standard deductible rises from $615 in 2026 to $700 in 2027. After it, you pay 25% coinsurance until you reach the cap.
- After the cap, you pay $0 for covered Part D drugs through December 31. Your monthly premium continues.
- Payments made for you by Extra Help count toward the cap. Drugs your plan doesn't cover, drugs bought abroad and the $50 GLP-1 Bridge do not.
- The cap resets every January 1, and it applies to standalone Part D plans and Medicare Advantage plans with drug coverage.
Every Medicare drug plan now has a ceiling on what you pay for covered prescriptions in a year. For 2026 that ceiling is $2,100. For 2027 plans, which you pick during the Annual Enrollment Period from October 15 to December 7, 2026, it is $2,400.
The cap is the single biggest protection in Part D. It is also easy to misread, because it doesn't cover everything you spend on prescriptions.
How much is the Part D cap in 2026 and 2027?
The cap is $2,100 in 2026 and $2,400 in 2027. CMS set both figures in its rate announcements, and Medicare.gov lists them on its Part D costs page. Here is how the standard Part D benefit fits together.
| Standard Part D benefit | 2026 | 2027 |
|---|---|---|
| Maximum deductible | $615 | $700 |
| What you pay after the deductible | 25% coinsurance | 25% coinsurance |
| Yearly out-of-pocket cap | $2,100 | $2,400 |
| What you pay after the cap | $0 for covered drugs | $0 for covered drugs |
Plans can design their copays differently, and some have a lower deductible or none at all. But no plan can make you pay more than the cap for covered Part D drugs. The rule applies to standalone drug plans and to Medicare Advantage plans that include drug coverage. Plan availability, premiums, drug lists and pharmacy networks vary by county and change every year, so the cap is the one number you can count on.
What counts toward the cap?
The cap counts your out-of-pocket spending on drugs your plan covers. That includes:
- The deductible you pay at the start of the year
- Copays and coinsurance on drugs on your plan's drug list (the formulary)
- Drugs your plan covers after your doctor gets an exception approved
- What you pay for covered insulin, which can't be more than $35 for a month's supply
- Certain payments made on your behalf, such as through Extra Help
- Contributions from a State Pharmaceutical Assistance Program, which CMS says may count
Vaccines recommended for adults, like the shingles and RSV shots, already cost $0 under Part D, so they don't move you toward the cap.
What doesn't count toward the cap?
These costs sit outside the cap. You pay them even after you reach it.
- Your monthly plan premium. It is a separate bill all year.
- Part D IRMAA. Higher-income people pay a surcharge on top of the premium, from $14.50 to $91.00 a month in 2026. It is separate from the cap. Our IRMAA guide has the brackets.
- Drugs your plan doesn't cover. If you pay cash for a drug that isn't on your plan's list, that money usually doesn't count.
- Drugs bought outside the U.S. Medicare drug plans don't cover them.
- The Medicare GLP-1 Bridge. The $50 a month that people pay for certain weight-loss drugs under the Bridge, which runs through December 31, 2027, does not count toward the deductible or the cap.
- Part B drugs. Drugs given in a doctor's office or infusion center usually fall under Part B, not Part D.
When will you reach the cap? A worked example
Here is how the standard 2027 benefit plays out for someone taking one brand-name drug that costs the plan $1,000 a month. This is an illustration of the standard design, not a quote for any plan.
| Month (2027) | What you pay | Your running total |
|---|---|---|
| January | $700 deductible, plus 25% of the remaining $300 = $775 | $775 |
| February | 25% of $1,000 = $250 | $1,025 |
| March | $250 | $1,275 |
| April | $250 | $1,525 |
| May | $250 | $1,775 |
| June | $250 | $2,025 |
| July | $250 | $2,275 |
| August | $125 (you reach the cap) | $2,400 |
| September to December | $0 | $2,400 |
The same drug in 2026 would have hit the $2,100 cap a little earlier. Notice the front-loading. This person pays $775 in January alone. That is exactly the problem the Medicare Prescription Payment Plan was built for. It lets you spread these costs across the year in monthly bills, with no interest or fees.
Does the cap mean every plan costs the same?
No. The cap only sets the worst case for covered drugs. Plans still differ in ways that change your total cost for the year:
- Which drugs are covered. A drug that isn't on a plan's list doesn't get the cap's protection at all.
- How drugs are tiered. One plan may put your medication on a low copay tier. Another may run it through the deductible.
- The deductible. Many plans use the full $700 in 2027. Some use less.
- The premium. Two plans can cap you at the same $2,400 but charge very different monthly premiums.
- The pharmacy network. Preferred pharmacies often cost less than standard ones in the same plan.
For someone who takes only a couple of low-cost generics, the cap may never come into play. For them, the premium and the generic copays matter far more. For someone with a high-cost brand drug, the cap matters most, and the premium becomes the tiebreaker.
That is why every review should start with your actual medication list. The Part D plans page explains how plans are built, and our comparison of standalone Part D vs Medicare Advantage drug coverage covers the other big choice.
Why did the cap go up in 2027?
CMS updates the deductible and the cap every year in its annual rate announcement. It announced the $2,400 threshold and the $700 deductible on April 6, 2026. The 2027 plan year also brings other shifts, including a higher national base premium ($41.33, up from $38.99) and the end of the Part D Premium Stabilization Demonstration after 2026. Our article on Part D changes for 2027 has the full picture.
You can look up your own plan's 2027 costs on Medicare.gov's Plan Finder, call 1-800-MEDICARE (1-800-633-4227, available 24 hours a day, 7 days a week; TTY 1-877-486-2048), or ask Nebraska SHIP for unbiased counseling at 1-800-234-7119. If you'd like someone to run your medication list across the plans in your county, talk to me.
Frequently asked questions
The Part D out-of-pocket threshold is $2,400 in 2027, up from $2,100 in 2026. CMS finalized it in the CY 2027 Rate Announcement on April 6, 2026. Once your out-of-pocket spending on covered Part D drugs reaches $2,400, you pay nothing more for covered drugs for the rest of 2027. The cap applies to every Medicare drug plan, including Medicare Advantage plans with drug coverage.
No. The cap applies to what you spend on covered Part D drugs: your deductible, copays and coinsurance. Your monthly plan premium is a separate bill that continues all year, even after you reach the cap. If you have Part D IRMAA because of higher income, that surcharge is also separate and keeps going.
Yes. The cap runs on the calendar year, January through December. On January 1 your spending starts over at $0 and the new year's deductible applies again. That is why people with steady high drug costs often reach the cap in the first half of the year, and why the Medicare Prescription Payment Plan can help spread those early costs out.
Generally no. The cap counts spending on drugs your plan covers. If you pay cash for a drug that isn't on your plan's drug list, that money usually doesn't count. If your doctor gets an exception approved and the plan covers the drug, your cost for it counts. Drugs bought outside the United States are never covered by Medicare drug plans.
Yes. If your Medicare Advantage plan includes Part D drug coverage, the same $2,400 cap applies to your covered Part D drugs in 2027. It is separate from the plan's medical out-of-pocket maximum, which covers doctor and hospital costs. Drugs given in a doctor's office under Part B count toward the medical side instead.
You will if your share of covered drug costs adds up to $2,400 during the year. Under the standard benefit, that means paying the $700 deductible and then 25% coinsurance on another $6,800 of drug costs. People taking one expensive brand-name drug or many medications often get there. Your plan's own copays may get you there faster or slower.
Sources
- Medicare.gov: Costs for Medicare drug coverage (opens in a new tab)
- CMS: CY 2027 Medicare Advantage and Part D Rate Announcement (opens in a new tab)
- Medicare.gov: What's the Medicare Prescription Payment Plan? (CMS Product No. 12211) (opens in a new tab)
- Medicare.gov: Insulin coverage (opens in a new tab)
- Medicare.gov: Medicare GLP-1 Bridge (CMS Product No. 12234) (opens in a new tab)
- CMS: 2027 Medicare Advantage and Part D state-by-state fact sheets (opens in a new tab)
- KFF: Part D stand-alone drug plan premiums for 2027 (Oct 2, 2026) (opens in a new tab)
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (1-800-633-4227) is available 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.
