Starting January 1, Medicare Part D costs are going up for 2027. The standard deductible rises to $700 and the annual out-of-pocket cap rises to $2,400. If your covered drug costs reach the cap every year, that’s up to $300 more than in 2026. Both increases come from the same 13.65% annual index CMS applied to 2027, so your plan doesn’t set them.

The good news is that there’s still time to act, and there are real options. Open Enrollment runs October 15 through December 7, and if you’ve already reached your 2026 limit, covered prescriptions you fill before December 31 cost you nothing. With a little planning, you can get ahead of the change and get more out of the plan you already have.

What’s changing in Part D in 2027, and who will notice?

• The deductible rises to $700. That’s the ceiling for the standard benefit. Individual plans may charge less or no deductible at all.
• The out-of-pocket cap rises to $2,400. Once your spending on covered drugs reaches it, you pay $0 for covered drugs for the rest of the year.
• No donut hole. The old coverage gap is gone, so costs move from the deductible to copays or coinsurance to the cap.
• Insulin stays protected. Covered insulin is capped at $35 for a one-month supply with no deductible.
• Premiums vary by plan. CMS projects the average stand-alone premium will rise less than $1 a month, from $35.09 to $36, but some members will see much larger increases.

Not everyone will feel the change. If your costs stay under the cap, the cap itself changes nothing you pay. Your plan’s deductible, copays, and pharmacy network do. The people who gain the most from planning ahead are those who reach the cap.

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Already hit your 2026 max? Here’s how to make the most of it before December 31

If you’ve reached $2,100 this year, you won’t pay out of pocket for covered Part D drugs for the rest of the calendar year. On January 1 the deductible resets, and your first 2027 fills could cost more. So the next few weeks are a good window to line up what you’ll need while your covered drugs are still $0.

Questions worth asking your prescriber and your plan:

• Which refills come due in early 2027? Many plans release a refill once about 75% of the supply is used, but each plan sets its own limit, so ask when your next refill is allowed.
• Can a stable maintenance medication move to a 90-day supply? Plans must let you get a 90-day supply at any in-network retail pharmacy, not just by mail, though the retail copay can be higher. After you hit the cap, that copay is $0.
• Is there a covered prescription you’ve been putting off because of cost? If your doctor has recommended it, now is a good time to talk about whether to fill it while it costs nothing.
• Do you need extra time for shipping? Mail-order prescriptions can take 7 to 14 days to arrive, so order early.
• Are you traveling? Plans often allow a vacation override that moves your refill window forward.

Not sure whether you’ve reached the cap? Check your Explanation of Benefits. It shows your coverage stage and what counts toward your out-of-pocket costs. If you’re close, your EOB is the most reliable way to see how far along you are, since pharmacy receipts may not reflect payments made on your behalf. It can also show whether a December fill would get you across the line.

A few ground rules. This only applies to covered drugs, and your plan’s refill rules still apply. Take your medications as prescribed, and don’t skip or stretch doses to make the timing work. Any change should go through your prescriber.

What counts toward your cap, so every dollar works for you

Knowing what counts helps you avoid spending that doesn’t move you toward $0.

Counts toward the cap:

• Deductibles, copayments, and coinsurance on covered drugs
• Payments made on your behalf through Extra Help, a State Pharmaceutical Assistance Program, or most charities

Doesn’t count:

• Your monthly premium and your plan’s share of costs
• Drugs your plan doesn’t cover and medications billed under Part B
• Drugs bought with a discount card instead of your Medicare plan

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Worried about a big bill in January? The Prescription Payment Plan can help

If your costs tend to land early in the year, this option can ease the strain. The Medicare Prescription Payment Plan spreads your out-of-pocket drug costs across the calendar year. It costs nothing to join, and you get a monthly bill from your plan instead of paying at the pharmacy. If you’d reach the full $2,400 cap in January, that works out to roughly $200 a month over 12 months. That’s an illustration, and your actual bill depends on when you fill.

What to know first:

• It doesn’t lower your total. It might help you manage monthly expenses, but it doesn’t save you money.
• Everyone with Part D can use it. Every plan must offer it, and participation is voluntary.
• It renews automatically. Your plan renews your participation each year unless you change plans or contact your plan to leave.
• Switching plans ends it. Your participation ends with your old plan, and the balance you owe stays with that plan. You’ll need to opt in again with a new plan.
• Stay current on payments. Falling behind could get you removed from the option.
• It may not be your best tool. Medicare notes it may not fit if you get or qualify for Extra Help or a Medicare Savings Program.

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Paying cash for a drug your plan doesn’t cover? A formulary exception may help

This is one of the most overlooked fixes. Cash spending on an off-formulary drug never counts toward the cap, so you can pay for months without getting closer to $0.

A formulary exception asks your plan to cover the drug. It can also waive a rule on a covered drug, such as step therapy, prior authorization, or a quantity limit. A tiering exception asks for a non-preferred drug at the lower cost of a preferred tier.

• Your prescriber has to support it. Your doctor must provide a statement explaining why the drug is medically necessary and that you’d face negative health effects on the alternative.
• Anyone can start the request. You, your prescriber, or your representative can ask.
• The plan has a deadline. It must decide within 72 hours, or 24 hours if expedited, and the clock starts once it receives your prescriber’s statement.
• A denial isn’t final. You can appeal within 65 days of the denial notice.
• Approvals are temporary. An approved exception generally lasts through the end of the plan year, so check your 2027 drug list in your Annual Notice of Change.

If an exception isn’t realistic, Open Enrollment is the other fix. Check each plan’s covered drug list to make sure your medications are on it.

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Could Extra Help bring your costs down further?

For people with limited income, Extra Help can change the whole picture. It helps pay Part D premiums, deductibles, coinsurance, and other costs. Social Security estimates it’s worth about $5,700 a year, and CMS has estimated up to 2 million people may qualify without being enrolled.

• Income test. The 2026 limit is 150% of the poverty level, $23,940 for one person and $32,460 for a couple, plus a limit on savings and investments. Your home and one vehicle aren’t counted.
• Some people qualify automatically. That includes people with both Medicare and Medicaid, a Medicare Savings Program, or SSI.
• Lower costs per prescription. In 2027, copays are capped at $5.80 for generics and $14.40 for brand-name drugs.
• It can open a switching window. Extra Help comes with a Special Enrollment Period to change drug plans.

Apply any time through Social Security at 1-800-772-1213. 2027 income limits haven’t been published yet, so use the 2026 numbers as a guide.

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How can a Solace advocate help you get ahead of 2027?

Between the cap, plan rules, and deadlines, there’s a lot to track, and a missed step can cost real money. A Solace advocate can help you:

• Time refills and 90-day fills before 12/31 if you’ve reached the 2026 cap, working within your plan’s rules and your prescriber’s guidance
• Enroll you in the Medicare Prescription Payment Plan and explain what happens if you switch plans
• Request formulary exceptions by coordinating with your prescriber so the supporting statement has what your plan needs
• Screen you for Extra Help and related programs, then help with the applications

Before Open Enrollment closes December 7, compare plans on total yearly cost, not just the premium. Read your Annual Notice of Change, compare total cost in Plan Finder, and check Extra Help and Medicare Savings Programs before assuming you don’t qualify.

Getting started takes three steps. You answer a few quick questions about your insurance and health situation, then meet with a Solace physician for a short virtual intro visit of about 20 minutes. Your advocate takes it from there, finding programs you may qualify for, handling the paperwork, and following up until it’s resolved. For eligible patients, advocacy is covered by Medicare and many insurance plans.