In short
- For 2027, the Part D deductible is at most $700 and your out-of-pocket cost for covered drugs is capped at $2,400. After that, you pay nothing more for covered drugs that year.
- Nebraska drops from 11 standalone Part D plans in 2026 to 9 in 2027. SilverScript Choice and HealthSpring Extra Rx are not offered in Nebraska for 2027.
- A CMS program that limited standalone drug plan premium increases ended after 2026, so read your plan's Annual Notice of Change before December 7.
- The right plan depends on your exact medications, doses and pharmacy. Plan availability, premiums and drug lists vary by plan and change every year.
- Going 63 days or more without creditable drug coverage can mean a lifelong penalty of 1% of $41.33 (the 2027 base) for each month you went without.
Every Medicare review I do starts with your medications. Part D is where that matters most, because the same prescription can cost very different amounts depending on the plan, the tier and the pharmacy. Here's how Part D works in Nebraska, what changes for 2027, and how I run your list.
How does Part D work?
Part D is Medicare's prescription drug coverage, sold by private companies that contract with Medicare. You get it one of two ways:
- A standalone drug plan (PDP) alongside Original Medicare, often with a Medicare Supplement. Supplements don't cover drugs, so this is how supplement owners get prescription coverage.
- A Medicare Advantage plan with drug coverage (MA-PD). The drug benefit is built into the plan. See Medicare Advantage.
Either way, you pay the drug plan's premium on top of your Part B premium. If your income is above $111,000 (single) or $222,000 (married filing jointly) on your 2025 tax return, you'll also pay an income-related amount for Part D in 2027, even inside a Medicare Advantage plan. My IRMAA page explains how that works.
Each plan has its own formulary, which is its list of covered drugs, sorted into tiers. Lower tiers usually cost less. Plans can also use prior authorization, step therapy (trying a lower-cost drug first) and quantity limits. Nebraska is in Part D Region 25, along with Iowa, Minnesota, Montana, North Dakota, South Dakota and Wyoming, so standalone plans here are priced for that region.
What does Part D cost in 2026 and 2027?
The federal limits on plan design are set every year. Here are the official 2026 and 2027 numbers:
| Part D item | 2026 | 2027 |
|---|---|---|
| Highest allowed deductible | $615 | $700 |
| Your share after the deductible (standard design) | 25% | 25% |
| Cap on your out-of-pocket cost for covered drugs | $2,100 | $2,400 |
| What you pay after reaching the cap | Nothing more for covered drugs | Nothing more for covered drugs |
| Covered insulin | No more than $35 for a month's supply, no deductible | No more than $35 for a month's supply, no deductible |
| Base premium used for the late penalty | $38.99 | $41.33 |
| Extra Help, most you pay per drug | $5.10 generic, $12.65 brand | $5.80 generic, $14.40 brand |
Recommended adult vaccines covered by Part D, like shingles, Tdap and RSV, have no deductible and no copay.
Plans can use copays instead of 25% coinsurance, and some have lower deductibles. The premium, deductible and tier for each of your drugs are set by the plan and change every year.
Why are standalone Part D premiums changing for 2027?
A CMS program called the Part D Premium Stabilization Demonstration, which held down premium increases for standalone drug plans, ended after 2026. At the same time, the national average monthly bid plans submitted rose from $239.27 for 2026 to $296.05 for 2027. Put those together and many standalone plans are repricing.
Here's what the national and Nebraska numbers show:
- Nationally: CMS projects the average total standalone premium will move from $35.09 to about $36 a month. KFF reports standalone plans falling from 360 to 316, and that some enrollees could pay much more if they don't switch. KFF also found that every standalone plan will charge a monthly premium in 2027 to people who don't get Extra Help.
- In Nebraska: CMS counts 9 standalone plans from 5 companies for 2027, down from 11. The lowest standalone premium in the state is $5.30 a month, and CMS says every Nebraska standalone plan enrollee has access to a plan with a lower premium than they paid in 2026.
- Leaving Nebraska: SilverScript Choice (CVS) and HealthSpring Extra Rx are not offered here for 2027, according to the CMS landscape files. If you have one of them, you need to choose a new plan.
What should you do if your drug plan is leaving or changing a lot?
Act during Annual Enrollment, October 15 to December 7, 2026, so your new plan starts January 1, 2027. If your plan is leaving Nebraska, it will send you a notice, and you also get a Special Enrollment Period from December 8 through the last day of February. Don't count on being moved to a new plan automatically. Read the letter, then compare plans for your actual medications. My annual review page has the full fall checklist.
How do I run your medication list?
I start with medications every time. Here's how the comparison works:
- Every prescription, exactly. The name, the dose, how many pills, and how often. A 90-day supply and a 30-day supply can price differently.
- Your pharmacy. Many plans have preferred pharmacies that charge less, and some offer mail order. If you want to keep using the pharmacy down the street, we price it that way.
- Every plan, total cost. I look at the premium plus what you'd pay for your drugs over the full year, not the premium alone. A low premium with your main drug on a high tier can cost more by spring.
- The one that throws you over the top. Usually one medication drives the cost. We ask what options we have to bring that one down: a different tier, a generic or biosimilar your doctor agrees to, or a plan that covers it differently.
- The rules. Prior authorization, step therapy and quantity limits. If your doctor says you need a drug on a higher tier, you can ask the plan for an exception.
- Again next fall. Formularies, tiers and pharmacy networks change every year.
For some people, the cap decides everything. I have a client on dozens of medications who's going to hit the $2,400 maximum no matter which plan we choose. For that kind of list, we focus on premium, pharmacy access and how fast you reach the cap.
What counts toward the $2,400 cap?
The cap counts what you pay for covered Part D drugs: your deductible, copays and coinsurance. Certain payments made on your behalf, like Extra Help, count too. Once that total hits $2,400 in 2027, you pay nothing more for covered drugs for the rest of the calendar year.
A few things sit outside it. Your monthly premium is a separate cost. Drugs your plan doesn't cover don't count unless you win an exception. And the $50 a month you'd pay through the Medicare GLP-1 Bridge for certain weight-loss drugs doesn't count toward the cap either. My page on the Part D out-of-pocket cap walks through examples.
Can you spread drug costs out or get help paying?
Yes, in several ways:
- The Medicare Prescription Payment Plan spreads your out-of-pocket drug costs into monthly bills across the year instead of paying at the counter. It doesn't lower your costs. If you're in it and stay in the same plan, your participation renews automatically for 2027. If you switch plans, you have to opt in again. See the payment plan page.
- Extra Help lowers drug costs for people with limited income and resources. The 2026 limits are $23,940 in income and $18,090 in resources for an individual, and $32,460 and $36,100 for a married couple. The 2027 limits aren't out yet. In Nebraska, 16.70% of standalone plan enrollees get Extra Help, and people with Medicaid or a Medicare Savings Program qualify automatically. More on Extra Help.
- The Medicare GLP-1 Bridge sets a $50 monthly cost for Wegovy, Zepbound KwikPen and Foundayo when prescribed for weight management, for people who meet the eligibility rules, through December 31, 2027. Your prescriber has to send a prior approval form. I'm not a doctor, so that conversation starts with yours.
- Negotiated prices. On January 1, 2027, Medicare's negotiated prices for 15 more drugs take effect, including Ozempic, Rybelsus and Wegovy, Trelegy Ellipta, Xtandi, Linzess and Tradjenta. CMS projects about $685 million in out-of-pocket savings for enrollees in 2027. What you pay still depends on your plan's tiers. Background is on my drug price negotiation update.
What is the Part D late enrollment penalty?
If you go 63 days or more in a row without Part D or other creditable drug coverage after your Initial Enrollment Period, you can owe a penalty for as long as you have Part D. It's 1% of the national base premium for each full month you went without, rounded to the nearest 10 cents. People who get Extra Help don't pay it.
Example: 20 months without coverage is 20% of the 2027 base premium of $41.33, which is $8.27, rounded to $8.30 a month in 2027. Because the base premium can change each year, the penalty can too. Creditable coverage from an employer, union, TRICARE, the Indian Health Service or the VA protects you, and your plan must tell you each year whether it counts. See late enrollment penalties.
Standalone plan or Medicare Advantage drug coverage?
It depends on the rest of your coverage. If you have Original Medicare, with or without a supplement, you need a standalone plan. If you choose Medicare Advantage, you'd generally use the plan's built-in drug coverage. My page on standalone Part D vs Medicare Advantage drug coverage compares them, and Part D in 2027 tracks the latest changes. Plan premiums, formularies and pharmacy networks vary by plan and change every year.
You can compare every plan for your drugs on Medicare.gov's Plan Finder, or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week (TTY 1-877-486-2048). Nebraska SHIP (formerly SHIIP) helps with plan comparisons at 1-800-234-7119. If you'd like me to run your medication list against the 2027 plans, talk to me. My help costs you nothing, and you make the final call.
Frequently asked questions
For 2027, a Part D plan's deductible can be no more than $700, up from $615 in 2026. Some plans have a lower deductible or none, and some cover drugs on certain tiers before the deductible. Insulin never has a deductible, and recommended adult vaccines like shingles and RSV have no deductible either. Your plan's Annual Notice of Change shows its 2027 deductible.
Your out-of-pocket costs for covered Part D drugs are capped at $2,400 in 2027, up from $2,100 in 2026. Once you, or programs like Extra Help on your behalf, reach that amount, you pay nothing more for covered Part D drugs for the rest of the calendar year. Your monthly plan premium is a separate cost, so add it when you figure your worst case.
You don't have to join, but there's a catch. If you go 63 days or more in a row without Part D or other creditable drug coverage after your Initial Enrollment Period, you can owe a late enrollment penalty for as long as you have Part D. Many people with no prescriptions choose a low-premium plan so they're covered and avoid the penalty if their health changes.
Usually only during the Annual Enrollment Period, October 15 to December 7, for coverage starting January 1. Exceptions include moving, losing other coverage, your plan leaving your area, or getting Extra Help or Medicaid, which allows a change once a month. If you're in Medicare Advantage, the January 1 to March 31 Open Enrollment Period also allows one change.
CMS says Nebraska has 9 standalone Part D plans for 2027, down from 11 in 2026, from 5 companies. Nebraska is in Part D Region 25 with Iowa, Minnesota, Montana, North Dakota, South Dakota and Wyoming. Many of the state's 48 Medicare Advantage plans also include drug coverage. Plans and premiums change every year, so compare for 2027 even if you liked your 2026 plan.
It can. Drug coverage from a current or former employer or union, TRICARE, the Indian Health Service or the VA can count as creditable coverage, which means it's at least as good as standard Part D. Your plan must tell you each year whether its drug coverage is creditable. Keep those letters, because you may need them to avoid a penalty if you join Part D later.
Sources
- Medicare.gov: Costs for Medicare drug coverage (opens in a new tab)
- Medicare.gov: Medicare & You 2027 (opens in a new tab)
- CMS: CY 2027 Medicare Advantage and Part D Rate Announcement (opens in a new tab)
- CMS: Medicare Part D 2027 national average monthly bid amount (opens in a new tab)
- CMS: Medicare Open Enrollment state fact sheets, 2027 (Nebraska) (opens in a new tab)
- KFF: Part D stand-alone drug plan premiums for 2027 (October 2, 2026) (opens in a new tab)
- CMS: Negotiated prices for 2027 (opens in a new tab)
- Medicare.gov: Medicare GLP-1 Bridge (CMS Product No. 12234) (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.
