Medicare Part D: What It Costs and What’s Changing in 2027

On this page

• What Part D covers and how you get it
• Part D costs in 2026 and 2027
• What the 2027 plan market looks like
• Negotiated drug prices that start in 2027
• Spreading costs with the Medicare Prescription Payment Plan
• Insulin and vaccines
• The late enrollment penalty
• Extra Help with drug costs
• How to compare plans during open enrollment
• Frequently asked questions

What Part D covers and how you get it

Part D helps pay for brand-name and generic prescription drugs. It’s optional, but Medicare suggests getting it even if you don’t take drugs now, because joining later can mean a penalty that lasts as long as you have coverage.

You can get it two ways:

• A stand-alone drug plan that you add to Original Medicare.
• A Medicare Advantage plan with drug coverage. Most Medicare Advantage plans include it. If your HMO-POS or PPO plan doesn’t cover drugs, you can’t add a separate drug plan; joining one switches you to Original Medicare.

Each plan has its own drug list, called a formulary, with drugs sorted into tiers. A drug on a lower tier usually costs less. Plans must cover most drugs in protected classes such as cancer and HIV drugs. They can change their lists during the year under Medicare’s rules, and they have to tell you about changes that affect drugs you take. Part D generally doesn’t cover drugs used only for weight loss, though a separate, temporary Medicare GLP-1 Bridge has offered Wegovy, Zepbound and Foundayo for weight management at $50 a month since July 2026 to people with Part D who meet its criteria. See insurance coverage for Wegovy, Zepbound and Ozempic.

Part D costs in 2026 and 2027

Part D figure	2026	2027
Out-of-pocket cap on covered drugs	$2,100	$2,400
Highest deductible a plan can charge	$615	$700
National base beneficiary premium (used for the late penalty)	$38.99	$41.33
Average stand-alone drug plan premium, per month	$35.09	$36 (CMS estimate)
Average drug premium in Medicare Advantage plans, per month	$11.32	$7 (CMS estimate)
Stand-alone drug plans nationwide	360	316

After the deductible, you pay copays or coinsurance until your out-of-pocket spending reaches the cap, and payments Extra Help makes for you count toward it. After that, covered Part D drugs cost you nothing for the rest of the calendar year. Your premium doesn’t count toward the cap, and you keep paying it. Higher earners also pay a surcharge on top: in 2026, $14.50 to $91.00 a month for individuals with income above $109,000. See the Part B premium and IRMAA brackets.

What the 2027 plan market looks like

CMS released its 2027 premium figures on September 28, 2026. It expects the average stand-alone plan premium to rise less than $1 and the average Medicare Advantage drug premium to fall to $7.

A temporary premium stabilization demonstration, which since 2025 trimmed stand-alone plan premiums and limited increases, ends after 2026. KFF’s review of the 2027 plans found:

• 316 stand-alone plans nationwide, down from 360. Most states have 8 or 9.
• No $0-premium stand-alone plans for people without Extra Help. About 4 million of them paid no premium in 2026.
• Increases of $50 a month or more in every state and DC for people who keep AARP Medicare Rx Preferred.

Negotiated drug prices that start in 2027

Medicare’s first 10 negotiated drug prices took effect in 2026. Negotiated prices for 15 more take effect January 1, 2027: Austedo and Austedo XR, Breo Ellipta, Calquence, Ibrance, Janumet and Janumet XR, Linzess, Ofev, Otezla and Otezla XR, Ozempic, Rybelsus and Wegovy, Pomalyst, Tradjenta, Trelegy Ellipta, Vraylar, Xifaxan and Xtandi.

These drugs treat conditions including type 2 diabetes, asthma, COPD, and prostate and breast cancer, and about 5.3 million people with Part D used them in 2024. CMS estimates people with Medicare will save $685 million in out-of-pocket costs when these prices take effect in 2027. You’ll notice it most if you pay coinsurance, which is a percentage of the price. A flat copay may not change.

Spreading costs with the Medicare Prescription Payment Plan

Every Medicare drug plan offers this free option. Instead of paying at the pharmacy, you get a monthly bill from your plan that spreads your out-of-pocket drug costs over the rest of the year, with no interest or fees. It doesn’t lower what you owe. If a prescription in January 2027 takes you straight to the $2,400 cap, you’d pay about $200 a month instead of $2,400 at once.

• You can join any time during the year, and it renews automatically each year unless you switch plans or tell your plan to stop.
• If you miss a payment and don’t pay by the date on the reminder, you’re dropped from the payment plan, but you keep your drug coverage.
• Medicare says it may not be the best choice if you get, or qualify for, Extra Help.

Insulin and vaccines

Each covered insulin costs no more than $35 for a one-month supply, with no deductible, and the limit applies to everyone, including people with Extra Help. See insulin coverage.

Part D plans can’t charge a copay or apply a deductible for vaccines recommended by ACIP, the CDC’s vaccine advisory committee. That includes the shingles, RSV and whooping cough vaccines. See vaccine coverage.

The late enrollment penalty

If you go 63 days or more in a row without Part D or other creditable drug coverage after your initial enrollment period ends, you can owe a penalty for as long as you have Part D. It’s 1% of the national base beneficiary premium for each full month you went without coverage, rounded to the nearest 10 cents. After 24 months without coverage, that’s about $9.40 a month in 2026 and $9.90 a month in 2027. People who get Extra Help don’t pay it. See Medicare late enrollment penalties.

Extra Help with drug costs

Extra Help, also called the Low-Income Subsidy, is for people with limited income and savings. For 2026, the limits are $23,940 in income for one person ($32,460 for a married couple) and $18,090 in resources ($36,100 for a couple). In 2027 it means a $0 deductible, copays of no more than $5.80 for generics and $14.40 for brand-name drugs, and a $0 premium if you pick a basic plan at or below your state’s Extra Help premium limit. You get it automatically if you have full Medicaid, a Medicare Savings Program or SSI. See Medicare Savings Programs and Extra Help.

How to compare plans during open enrollment

Open enrollment runs October 15 to December 7, 2026. If you switch, your new plan starts January 1, 2027, as long as it gets your request by December 7.

1. Read your Annual Notice of Change. Your plan sends it in September, and it lists what changes in January.
2. Use Medicare Plan Finder. At Medicare.gov/plan-compare, enter every drug with its dose and the pharmacies you use. 2027 plans have been listed since October 1, 2026.
3. Compare total yearly cost. Add the premiums to what you’d pay for your drugs. A plan with a low premium and a high deductible can cost more overall.
4. Check each drug’s tier and rules, such as whether the plan has to approve it before covering it.

If you’re in a Medicare Advantage plan, you can also switch plans, or go back to Original Medicare and add a drug plan, from January 1 to March 31. Your State Health Insurance Assistance Program (SHIP) offers free help comparing plans. See Medicare open enrollment and Medicare Advantage vs. Medigap.

Not on Medicare yet, or shopping for a spouse under 65? Compare health plans by ZIP code.

Frequently asked questions

How much does Part D cost in 2027?

CMS estimates the average stand-alone plan premium at $36 a month, but premiums vary by plan and state. You may also pay a deductible of up to $700, then copays or coinsurance until you reach the $2,400 cap.

Are there $0 premium Part D plans for 2027?

Not among stand-alone drug plans unless you get Extra Help, according to KFF. The drug part of Medicare Advantage premiums averages about $7 a month, according to CMS.

What happens after I reach the $2,400 cap?

You pay nothing for covered Part D drugs for the rest of 2027. You still pay your monthly premium.

This article is general information, not insurance, tax or legal advice. Premiums, drug lists and pharmacy networks vary by plan and state, so check your own plan’s 2027 details before you decide. Last reviewed October 2026.