Quick answer. The Part D out-of-pocket cap is $2,100 for 2026 and $2,400 for 2027. Once your out-of-pocket spending on covered Part D drugs reaches it, you pay nothing more for covered drugs that calendar year. Enter what you've paid each month to see how close you are.
How close am I to the cap?
Enter your monthly costs.
The Medicare rules
The cap and the deductible
Medicare.gov says the initial coverage stage lasts until your out-of-pocket spending on covered drugs "reaches $2,100 in 2026 ($2,400 in 2027)," and then you move to catastrophic coverage automatically. It also says "No Medicare drug plan may have a deductible more than $700 in 2027 ($615 in 2026)." CMS explains that the 2026 figure is the original $2,000 cap from 2025, adjusted by the annual percentage increase in Part D drug spending.
What counts
- Counts: what you pay for drugs your plan covers, and certain payments made on your behalf, such as through Extra Help. State Pharmaceutical Assistance Program contributions may count.
- Doesn't count: drugs bought with a discount card, according to Medicare's 2027 changes fact sheet.
- Ask your plan: anything else. Your plan's monthly Explanation of Benefits shows the running total it counted.
The Medicare Prescription Payment Plan
The Medicare fact sheet says anyone with a Medicare drug plan or a health plan with drug coverage can use it, and you can start any time during the year by contacting your plan. You pay the plan, not the pharmacy. Your first bill is the lesser of (the cap minus what you've already paid this year) divided by the months left, or that month's drug costs. After that, each bill is your remaining balance plus new costs, divided by the months left in the year (Medicare's worked examples). In a year you never pay more than you would have at the pharmacy, or the cap.
- It doesn't lower your drug costs, and there's no interest or fees.
- It tends to help most when big costs come early in the year; Medicare suggests joining before September (will this help me?).
- If a bill isn't paid by the date in the reminder, you're removed from the payment option. You can leave any time, and participation renews each year automatically.
Example with the 2027 cap: someone who joins in January with $600 of costs in each of the first four months gets bills of $200.00, $90.91, $150.91, $217.58, $217.58 and so on, $2,400 in all.
New to Medicare? The Turning 65 Medicare Checklist covers enrollment windows and penalties.
Sources
- Medicare.gov: How much does Medicare drug coverage cost?
- Medicare.gov: Your Medicare in 2027, what's new and changing
- Medicare.gov: What's the Medicare Prescription Payment Plan? (fact sheet, Sept. 2026)
- Medicare.gov: Examples of the Medicare Prescription Payment Plan
- Medicare.gov: Will this payment option help me?
- CMS: Final CY 2026 Part D Redesign Program Instructions
Sources checked November 2026.
An organizer and calculator only: general information checked November 2026 against the official sources above, not medical, insurance or benefits advice. It doesn't decide what you qualify for or owe. MCC Solutions is not affiliated with the IRS, CMS, Medicare, HealthCare.gov or Get Covered New Jersey. The tool runs in your browser, and nothing you enter is sent or saved.
Common questions
What is the Part D out-of-pocket cap?
Medicare.gov says out-of-pocket spending on covered Part D drugs is capped at $2,100 in 2026 and $2,400 in 2027. After you reach it, you automatically move to catastrophic coverage for the rest of the calendar year.
What counts toward the cap?
Spending on drugs your plan covers, including certain payments made on your behalf, such as through Extra Help; State Pharmaceutical Assistance Program payments may count too. Purchases with a drug discount card don't count. For anything else, ask your plan.
Do my monthly premiums count?
Medicare.gov describes the cap in terms of spending on covered Part D drugs and treats premiums as a separate monthly cost. This tracker counts drug costs only. Your plan's Explanation of Benefits shows what it counted.
What is the Medicare Prescription Payment Plan?
A payment option that spreads your out-of-pocket drug costs across the calendar year in monthly bills from your plan instead of paying the pharmacy. Medicare.gov says it doesn't save money or lower drug costs, and you won't pay interest or fees.
Do I have to sign up again each year?
The Medicare fact sheet says your plan automatically renews your participation every year unless you change plans or opt out. You can leave at any time by contacting your plan.
When can I change Part D plans for 2027?
Medicare's open enrollment runs October 15 to December 7. Use Medicare's plan finder or your plan's notices to compare costs.