Part D drug cap estimator for 2027

How does the 2027 cap work?

Since 2025, every Medicare drug plan, standalone or part of a Medicare Advantage plan, stops charging you for covered drugs once your own out-of-pocket spending reaches the yearly cap. In 2027 the cap is $2,400. The year has a deductible phase (up to $700 in 2027, and some plans charge less or none), then you share costs with your plan until you reach the cap, then you pay nothing for covered drugs. The old "donut hole" between those phases no longer exists.

The cap counts what you pay at the pharmacy for drugs on your plan's drug list. It doesn't count your monthly premium, drugs your plan doesn't cover, or drugs bought outside your plan, including drugs bought in another country. Covered insulin is limited to $35 for a month's supply, and those payments count toward the cap.

Drug plans in Florida

Florida is its own Part D region (PDP Region 11), so standalone drug plans sold here are priced for Florida. For 2027, CMS lists 11 standalone Part D plans in Florida from 6 companies, plus drug coverage in most Medicare Advantage plans. Plans change their drug lists and costs every year, so check your prescriptions against each plan's formulary during Open Enrollment, which ends December 7, 2026. If your plan is ending, see plans ending in 2027.

• Snowbirds. A standalone Part D plan's service area is the region, so a Florida plan is a Florida plan. If you spend part of the year up north, ask whether the plan's pharmacy network includes pharmacies there, or whether it offers mail order for your maintenance drugs. See snowbirds and Medicare.
• Hurricane season. Medicare.gov says that if you live in a declared disaster area, your plan can help you find another in-network pharmacy, replace lost or damaged drugs, and fill prescriptions out of network when you can't reasonably reach an in-network pharmacy. CMS has told Part D plans it expects them to lift "refill too soon" limits after a federal disaster declaration. See hurricanes and Medicare in Florida.
• State retirees. The State's group MA-PD plans include Part D, so the cap applies. The State Group Insurance PPO and HMO plans that pay secondary to Medicare have their own prescription coverage, which the State describes as creditable; their plan documents explain what you pay. Ask People First before joining any outside Medicare plan. See Florida state retirees and Medicare.

Can I spread the cost over the year?

If an expensive prescription would have you pay most of the cap in January, you can join the Medicare Prescription Payment Plan through your drug plan. You then pay nothing at the pharmacy and get a monthly bill from your plan instead. The total is the same; the bills are spread over the rest of the year. The calculator's monthly figure assumes you join for the whole year; joining later in the year spreads the cost over fewer months.

The payment plan helps most when costs come early and are high. If you qualify for Extra Help, Extra Help usually helps more, because it lowers what you owe instead of spreading it out.

Who gets Extra Help in Florida?

Extra Help is the federal program that lowers Part D costs for people with limited income and resources. With Extra Help you pay no deductible and, in 2027, no more than $5.80 for a generic or $14.40 for a brand-name drug. People with full Medicaid and income at or below the federal poverty level pay no more than $1.65 and $5. Extra Help can also pay all or part of your drug plan's premium.

• Automatic for many Floridians. If you have full Florida Medicaid, are in QMB, SLMB or QI, or get Supplemental Security Income, Medicare gives you Extra Help without a separate application. Read Florida Medicaid and Medicare.
• Others apply with Social Security. Extra Help has its own income and asset limits, and its asset limit is higher than the Medicare Savings Program limit, so some Floridians with too much in savings for QMB, SLMB or QI still qualify. The 2027 limits come out with the new federal poverty guidelines early in the year; check the current ones with the savings programs screener and see Extra Help in Florida.
• No state program for seniors. Florida doesn't run a state pharmaceutical assistance program for seniors, so Extra Help is the main source of help with Part D costs. See does Florida have a state drug assistance program for seniors?
• A chance to change plans. People with Extra Help can switch to a different drug plan once a month in some situations; see enrollment periods.

For all of next year's amounts, see Medicare costs in 2027. To look at plans offered where you live, you can check your drugs against plans for your ZIP code.

Sources

• Medicare.gov — Costs for Medicare drug coverage
• Medicare.gov — Medicare Prescription Payment Plan
• Medicare.gov — Help with drug costs (Extra Help)
• Medicare.gov — Getting drugs in a disaster or emergency
• CMS — Pharmacy access during a federal disaster or public health emergency: Q&A for Part D plan sponsors (PDF)
• Social Security — Extra Help with Medicare prescription drug costs
• CMS — CY 2027 Rate Announcement (Part D out-of-pocket threshold, deductible and Extra Help copays) (PDF)
• eCFR — 42 CFR 423.773, Requirements for eligibility (people treated as eligible for Extra Help)
• CMS — CY2027 Part D Landscape files (Florida, PDP Region 11)
• Florida Division of State Group Insurance — Frequently asked questions: retirees (Part D and creditable coverage)

Frequently asked questions