How the cap works in 2026 and 2027
Every Part D plan, and every Medicare Advantage plan with drug coverage, has the same yearly limit. In 2026, a plan can charge a deductible of up to $615. After that, you pay 25% coinsurance or a copay until your spending on covered drugs reaches $2,100.
After you reach the cap, you pay $0 for covered drugs until the year ends. For 2027, the maximum deductible is $700 and the cap is $2,400. The counter starts again at $0 each January 1.
| Plan year | Maximum deductible | Out-of-pocket cap | Base beneficiary premium |
|---|---|---|---|
| 2026 | $615 | $2,100 | $38.99 |
| 2027 | $700 | $2,400 | $41.33 |
What counts toward the cap, and what does not
The cap counts what you pay for drugs your plan covers: your deductible, copays and coinsurance. Your monthly premium does not count. A drug that is not on your plan's list of covered drugs does not count either.
That is why the drug list matters as much as the cap. Two plans with the same $2,100 limit in 2026 can cost you very different amounts if one covers your medicines and the other does not. Our drug cost estimator shows how fast you might reach the cap.
Spreading the cost across the year
If you would hit the cap early, a large bill can land in January. The Medicare Prescription Payment Plan lets you pay your drug costs in monthly amounts instead. It is free and every plan offers it.
Medicare.gov is clear that it "doesn't save you money or lower your drug costs." It only smooths the timing. If you would rather talk it through, call 888-661-0126 and ask for a plain-language answer.