Frequently Asked Questions About the 2027 Medicare Part D Cap
What happens once I spend $2,400 out of pocket?
Once your qualifying out-of-pocket spending hits $2,400, you enter the catastrophic coverage phase. You pay $0 for all covered Part D medications for the remainder of 2027.
This $0 copayment benefit lasts through December 31, 2027. On January 1, 2028, your out-of-pocket spending counter resets for the next plan year.
Do monthly plan premiums count toward the $2,400 cap?
No, monthly plan premiums do not count toward the $2,400 out-of-pocket cap. The cap applies strictly to True Out-of-Pocket (TrOOP) spending at the pharmacy.
Only payments made toward your Part D deductible, copayments, and coinsurance count toward the threshold. Non-covered medications and premium payments are excluded.
Can I still get a zero-dollar premium stand-alone plan in 2027?
For 2027, $0-premium stand-alone Part D plans are no longer available on the open market. This change affects roughly 4 million beneficiaries who held zero-dollar plans in 2026.
The only beneficiaries who can access $0-premium stand-alone drug plans are those who qualify for Extra Help. You can check your eligibility through the Social Security Administration.
How does the Medicare Prescription Payment Plan work with the $2,400 cap?
The Medicare Prescription Payment Plan does not lower your $2,400 cap or change your total drug costs. Instead, it spreads your out-of-pocket pharmacy bills into predictable monthly installments.
This program prevents you from paying large sums at the pharmacy counter early in the year. Your plan bills you directly each month until you hit the $2,400 cap.
HealthyHabits.care is an independent publication and is not connected with or endorsed by the U.S. government or the federal Medicare program. This article is general information, not insurance or legal advice. For free, unbiased help with your coverage, contact your State Health Insurance Assistance Program (SHIP) or call 1-800-MEDICARE.
