Medicare Part D cap: your yearly share and the month you reach it
Medicare Part D limits what you pay for covered drugs to $2,100 in 2026 and $2,400 in 2027; this calculator shows when you get there.
Since 2025 the Part D standard benefit has a hard ceiling on out-of-pocket spending, and CMS has published its level for two years: $2,100 in 2026 and $2,400 in 2027, in Table V-2 of the 2027 Rate Announcement. Below it, you pay the plan’s deductible, at most $615 in 2026 and $700 in 2027, then 25% of the cost of each covered drug. Once your share, including payments made for you by Extra Help, reaches the cap, covered drugs cost nothing for the rest of the calendar year. For a GLP-1 at list price the cap comes quickly: a year of Ozempic reaches it in July 2026. In 2027 the negotiated semaglutide price of $274 changes the arithmetic, and the same year of Ozempic costs about $1,347. The calculator computes your share, the month you hit the cap, and the monthly bill if you join the Medicare Prescription Payment Plan.
Paid at the pharmacy each month, without the payment plan
- January$718
- February$257
- March$257
- April$257
- May$257
- June$257
- July$97
- August$0
- September$0
- October$0
- November$0
- December$0
Your Part D share in 2026
$2,100
Cap reached in July
2026 defined standard benefit
- Drug cost a month (list price)$1,028
- Deductible$615
- Yearly out-of-pocket cap$2,100
- Payment plan, a month from January$175
After the $615 deductible you pay 25% of the cost until your share reaches $2,100; your plan may charge flat copays instead, never more than the cap. Estimate only. Method
Prices read by Radif Partners · Editorial policy · Method and data
The three stages, with the 2026 and 2027 figures
| Stage | 2026 | 2027 |
|---|---|---|
| Deductible, at most | $615 | $700 |
| Coinsurance after the deductible | 25 % | 25 % |
| Out-of-pocket cap | $2,100 | $2,400 |
| After the cap | $0 | $0 |
Plans may use copays instead of coinsurance and many have a lower deductible; none may ask more of you than the standard design over the year, and none may exceed the cap. The calculator applies the standard design, which is the upper bound.
What counts toward the cap
Everything you pay for covered Part D drugs counts, including the deductible, plus payments made on your behalf by Extra Help and certain assistance programs. What does not count: drugs your plan does not cover, cash purchases made outside the plan through TrumpRx or a maker’s self-pay program, and the $50 Medicare GLP-1 Bridge copay. This is why paying cash for a cheap drug can backfire for someone who would otherwise reach the cap.
Why the cap month matters
With an expensive drug, the whole yearly share falls in the first months: deductible in January, then a quarter of each fill until the ceiling. That is a cash-flow problem more than a total-cost one. Medicare’s answer is the Prescription Payment Plan, which bills the same amount every month from the month you join; it does not lower the total. The payment plan guide explains how to sign up.