There is now a ceiling on what you pay for prescriptions

For most of Part D's history there was no ceiling at all, which meant a few expensive medications could run to thousands of dollars a year with nothing to stop the meter.

That's changed. Covered prescription drugs now carry an annual limit on what you pay out of pocket, and it's one of the better changes to reach Medicare in a long while.

How it works

For 2026, once your out-of-pocket spending on covered Part D drugs reaches $2,100 in a calendar year, your plan covers 100% of your covered drug costs for the rest of the year. Not a reduced copay — nothing.

That applies whether your drug coverage is a standalone Part D plan or bundled into a Medicare Advantage plan.

Both numbers move for 2027, and both are already settled

The cap is indexed, so it climbs a little each year, and CMS has already published the 2027 figures.

	2026	2027
The most you pay for covered drugs	$2,100	$2,400
The most a plan may charge as a deductible	$615	$700

So that's three hundred dollars more before the ceiling catches you. If you're somebody who reaches it, that's a real change and it's the number to plan your year around.

What isn't settled is what any particular Colorado drug plan will charge. Carriers may not publish 2027 premiums or drug lists before October 1, so anyone quoting you one before then is guessing. We'll have them the week they land.

There's one more change moving underneath all this. A federal subsidy has been holding standalone drug plan premiums down since 2025, and CMS has announced that it ends with this plan year.

That's a change to what plans get paid rather than to what the coverage does — the cap, the insulin limit and drug price negotiation are all written into law, and none of them move with it. What it means for you is that the plan you have is more likely than usual to be repriced for next year, which makes this a season to re-shop rather than simply renew.

And on insulin, while we're here: a covered insulin product costs you no more than $35 for a month's supply and sometimes less, and the deductible doesn't apply to it at all. So that cap is working from your first fill in January rather than after you've spent your way to it.

If your drug coverage is bundled inside a Medicare Advantage plan, most of this passes you by. It lands on standalone Part D — which, in Colorado, is overwhelmingly the people who also hold a Medicare Supplement.

Who this actually changes things for

If you take one or more higher-cost medications — certain diabetes drugs, some cancer treatments, biologics for autoimmune conditions — then hitting the cap partway through the year turns an open-ended cost into a known one, and that's a very different year to budget for.

If your prescriptions are mostly low-cost generics, you may never come near the cap and it's close to irrelevant to you. The question that matters more in that case is which plan's formulary covers your specific medications at the lowest tier.

The mistake to avoid

The cheapest plan on paper often isn't the cheapest plan for you. Premiums vary across hundreds of plans with different drug lists, tiers and pharmacy networks, and a plan that saves you a few dollars a month can put one of your medications on a tier that costs several times the difference.

There's also one more option now that people don't know about: you can ask to spread your Part D out-of-pocket costs across the year in level monthly payments instead of paying them as they hit. It doesn't lower what you owe, but it does stop January costing what January sometimes costs.

What to have ready

Your medication list, with doses — that's the whole ask.

We check it against what a plan actually covers rather than what it advertises, and we'll tell you when your current plan is already the right one. Half an hour, no charge.