What is the Part D out-of-pocket cap in 2027?

This is the standard benefit set by CMS for every Part D plan, whether it is a stand-alone plan or part of a Medicare Advantage plan, so it is the same in Brighton, Adams County and everywhere else in Colorado. Premiums, drugs your plan does not cover and out-of-network pharmacy costs do not count toward it.

Part D standard benefit, 2026 compared with 2027

Part D feature	2026	2027
Maximum yearly deductible	$615	$700
Your share after the deductible	25%	25%
Out-of-pocket cap on covered drugs	$2,100	$2,400
Total drug cost at which the cap is reached	$6,555	$7,500
Stand-alone Part D plans offered in Colorado	10	8
Stand-alone plan premium range, monthly	$0 to $151.90	$5.30 to $260.20

How the 2027 cap works month by month

Your plan's deductible comes first, up to $700 in 2027. After that you pay 25% of each covered drug's cost until your own spending, the money you actually pay, reaches $2,400. From then on the plan covers the rest of the year.

Only your spending counts: what you pay, what a pharmacy assistance program pays for you and what certain other programs pay on your behalf. The plan's share does not.

Worked example: when does the cap kick in?

Take someone on brand-name medicines whose covered drugs cost $7,500 over the year at plan prices. They pay the $700 deductible, then 25% of the remaining $6,800, which is $1,700. That adds up to exactly $2,400, so everything after that costs $0.

Under the 2026 rules the same pattern stops at $2,100, reached once drug costs hit $6,555. The 2027 cap is $300 higher, which is the most a person with very high drug costs can be asked to pay for covered drugs in the plan year.

Why January can still feel expensive

The deductible and the 25% share land at the start of the year, so the first refill of a costly drug can be the largest bill of the year. Lisa often hears this in January. Medicare's Prescription Payment Plan lets you spread those costs across the months of the year instead of paying at the counter, and she can check with you whether it fits your situation.

What the cap does not change

A lower cap does not mean every plan costs the same. Premiums, formularies and pharmacy networks still differ, and Colorado has 8 stand-alone plans for 2027 against 10 in 2026. The sample of 31 Adams County Advantage plans with drug coverage all use the same $2,400 threshold, but their deductibles differ: 6 of the 36 have no Part D deductible, and the highest is $700.

Related questions

Sources

1. CMS Calendar Year 2027 Rate Announcement, Part D redesign parameters (Attachment V, Table V-6) Centers for Medicare & Medicaid Services
2. CMS Medicare Advantage and Part D Landscape, Contract Year 2027 Centers for Medicare & Medicaid Services
3. CMS Medicare Advantage and Part D Landscape, stand-alone Part D plans, Colorado, Contract Years 2026 and 2027 Centers for Medicare & Medicaid Services

Please note: We do not offer every plan available in your area. Currently we represent 10 organizations which offer 106 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.Headwaters Health and Wealth is not connected with or endorsed by the United States government or the federal Medicare program. Medicare has neither endorsed nor reviewed this information.