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. There is no longer a gap between those phases.

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. Covered insulin is limited to $35 for a month's supply, and those payments count toward the cap. In the mountains and the rural east, where the nearest pharmacy may be a long drive, check that a plan's network includes a pharmacy you can reach, or that it offers mail order for your maintenance drugs; see rural and mountain Medicare in North Carolina.

Drug plans in North Carolina

North Carolina is its own Part D region (PDP Region 08), so standalone drug plans sold here are priced for North Carolina. For 2027, CMS lists 11 standalone Part D plans in North Carolina 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.

State Health Plan retirees should check before joining a separate drug plan: the Plan says enrolling in another Medicare drug or health plan removes you from its group Medicare Advantage plan and moves you to the 70/30 Plan. See State Health Plan 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 North Carolina?

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 NC 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 North Carolinians. If you have full NC Medicaid, are in an MQB program (MQB-Q, MQB-B or MQB-E), or get Supplemental Security Income, Medicare gives you Extra Help without a separate application. Read NC Medicaid and Medicare.
• Others apply with Social Security. Extra Help has its own income and resource limits, and its resource limit is higher than the MQB limit, so some North Carolinians with too much in savings for MQB 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 North Carolina.
• No general state program. North Carolina doesn't run a state pharmaceutical assistance program for all seniors, so Extra Help is the main source of help with Part D costs. See does North Carolina have a prescription 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)
• 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 (North Carolina, PDP Region 08)
• State Health Plan — 2026 pre-65 retiree presentation (other Medicare plans and group Medicare Advantage) (PDF)

Frequently asked questions