The Part D deductible, coinsurance and yearly cap in 2027
Enter what your drugs cost each month: the calculator applies the 2027 standard benefit and shows when the $2,400 cap stops your spending.
Your pharmacy costs in 2027 (premiums apart)
$1,875
Under the $2,400 yearly cap
| Deductible paid | $700 |
| 25% coinsurance after the deductible | $1,175 |
| With the payment plan, per month | $156 |
| Same drugs under 2026 rules | $1,811 |
Compiled by Radif Partners · How the data is read · independent site, not affiliated with Medicare or any insurer
In 2027 the standard Part D benefit has three steps. You pay the full price of covered drugs until you reach the deductible of $700, up from $615 in 2026; then you pay 25% of the cost; and once your own spending reaches $2,400, up from $2,100, you pay nothing more for covered drugs until December 31. These amounts come from Attachment V of the CMS Rate Announcement of April 6, 2026, and apply to every drug plan, stand-alone or inside a Medicare Advantage plan. A plan can be more generous, with a lower deductible or flat copays, but never less. With full-price drugs of $625 a month or more, you reach the cap within the year. Covered insulin costs at most $35 a month and skips the deductible, and recommended adult vaccines cost nothing.
The three steps, in dollars
| Step | 2026 | 2027 | What you pay |
|---|---|---|---|
| Deductible | $615 | $700 | The full negotiated price |
| Initial coverage | 25% | 25% | A quarter of the price, or the plan’s copay |
| Out-of-pocket threshold | $2,100 | $2,400 | Nothing after it, until December 31 |
The yearly cap is reached when your own payments (deductible plus coinsurance or copays) add up to $2,400. Under the standard benefit that happens when the full price of your covered drugs reaches $7,500 for the year: $700 paid in full, plus 25% of the next $6,800. Someone whose drugs cost $6,000 a year pays $2,025; someone on a specialty drug costing $30,000 pays $2,400 and hits the cap in month 3.
Same drugs, 2026 rules against 2027 rules
Change for 2027
+$300
| 2026 ($615 / $2,100) | $2,100 |
| 2027 ($700 / $2,400) | $2,400 |
Your plan's own deductible
The standard deductible is a maximum. In the 2027 landscape file, 213 of the 323 stand-alone plan versions charge the full $700; the others charge less, and many Medicare Advantage plans charge $0 or apply the deductible only to brand-name tiers. A plan that "offers drug tiers with no deductible" covers its cheaper tiers from the first fill. Put your plan's figure in the second field of the calculator: it comes from the state or county list, in the column "Drug deductible".
Many plans replace the 25% with flat copays per tier, for instance a few dollars for a preferred generic and a percentage for specialty drugs. The calculator keeps the standard 25%, which is the legal benchmark: actual plans must be at least as generous on average, but a particular drug can cost you more or less than 25% in a particular plan. The plan's formulary and its Evidence of Coverage give the exact copay.
When a lower deductible is worth a higher premium
Compare twelve months of premium difference with the deductible saved. A plan that charges $25 a month more but has no deductible saves you up to $700 at the pharmacy, against $300 of extra premiums: worth it only if your drugs cost at least that much in the first months. If you take one cheap generic, the deductible may never be reached on that drug, and the cheaper premium wins. If you will reach the $2,400 cap anyway, the deductible changes nothing to your yearly total: you pay the cap in every plan, and only the premium separates them.
A large bill in January: the Medicare Prescription Payment Plan
With an expensive drug, the cap can fall due almost entirely in the first months of the year. Since 2025 every Part D plan must offer the Medicare Prescription Payment Plan (42 CFR 423.137): instead of paying at the pharmacy, you receive a monthly bill from the plan that spreads your out-of-pocket costs over the remaining months of the year, with no interest and no fee. The total does not change; only the timing does. Joining in January spreads the year over twelve bills. Joining later in the year spreads what is left over fewer months, so it helps less.
Spread the bill: the payment plan
Per month with the payment plan
$200
| January without it | $1,150 |
| Year total, the same either way | $2,400 |
Insulin, vaccines and Extra Help
Each covered insulin product costs at most $35 for a month's supply, whatever the plan and whether or not you have met the deductible; those payments count toward the cap. Adult vaccines recommended by the Advisory Committee on Immunization Practices, such as shingles and Tdap, cost nothing under Part D. People with Extra Help pay no deductible in 2027 and copays of at most $5.80 for a generic or $14.40 for a brand-name drug, or $1.65 and $5 with full Medicaid and income at or below the poverty line.
Extra Help: your 2027 drug copays
Most you pay a year (income 100-150% of poverty)
$382
| Generic copay | $5.80 |
| Brand copay | $14.40 |
| At or below 100% (full duals) | $119 |
What never counts toward the cap
- The monthly premium of the plan, and any IRMAA added to it.
- Drugs that are not on your plan's formulary, unless the plan approved an exception.
- Drugs bought outside the plan, for example with a discount card at a pharmacy, when the purchase is not submitted to the plan.
- Drugs covered by Part B instead of Part D, such as many infusions given in a doctor's office: they follow the 20% rule of Part B, or your Advantage plan's medical cap.
The cap resets every January 1. If you switch plans in the middle of the year, which is possible only with a special enrollment period, your spending already counted carries over to the new plan.