Idaho clients who take brand-name drugs ask two things: "What is the most I could pay?" and "Can I pay it over time?" For 2027 the first answer is written into federal rules: $2,400. The second is the Medicare Prescription Payment Plan. This page works through both with real 2027 CMS numbers. For plans, premiums and drug tiers, see our Part D 2027 guide for Idaho.
The Short Version: Key Takeaways
- The 2027 cap is $2,400, up from $2,100 in 2026. The standard deductible is $700, up from $615 (CMS CY2027 Rate Announcement).
- The standard benefit has three steps: you pay 100% until $700, then 25% of each drug's cost, then $0 once your costs reach $2,400.
- The cap counts what you pay for covered drugs, not your plan premium (42 CFR 423.100).
- One brand drug at $237.25 a month costs about $1,237 over 2027 and never reaches the cap. Two such drugs cost about $1,787. A drug at $2,418.70 a month reaches the cap in month 4.
- The Medicare Prescription Payment Plan spreads your bill over the year with no interest or fees. It does not reduce what you owe (42 CFR 423.137).
- Idaho has 8 standalone Part D plans for 2027, with premiums from $5.30 to $238 a month and deductibles from $300 to $700 (CMS Landscape file).
Not sure whether the cap or the payment plan applies to you?
Send us your drug list. We show you your likely 2027 costs plan by plan and tell you whether turning on the payment plan makes sense for your situation.
Call or text 208-350-9933 Send us a messageWhat Changed for 2027
Part D was redesigned beginning in 2025. CMS describes the change as capping yearly out-of-pocket costs, eliminating the coverage gap phase and eliminating cost sharing in the catastrophic phase (CMS Final CY 2026 Part D Redesign Program Instructions). The dollar amounts are updated each year, and for 2027 the annual percentage increase is 13.65% (Table V-1 of the Rate Announcement).
| Parameter | 2026 | 2027 |
|---|---|---|
| Deductible (you pay 100%) | $615 | $700 |
| Cost sharing after the deductible | 25% | 25% |
| Annual out-of-pocket threshold (the cap) | $2,100 | $2,400 |
| Your cost for covered drugs after the cap | $0 | $0 |
Source: CMS CY2027 Medicare Advantage and Part D Rate Announcement, Attachment V, Tables V-2 and V-6, accessed November 12, 2026.
Two cautions. The table shows the defined standard benefit; your plan may use a different design worth at least as much, such as a lower deductible or flat copays. And what you reach the cap with depends on your drugs, their prices and your pharmacy.
How the $2,400 Cap Works
Think of the year as three steps. In the deductible step you pay the full negotiated price until your spending reaches $700. In the coinsurance step you pay 25%. Once you have paid $2,400 on covered drugs, you are in the $0 step for the rest of the calendar year. The counter resets each January 1.
Federal rules call what counts "incurred costs": costs for covered Part D drugs your plan did not pay because of the deductible or cost sharing, paid by you or on your behalf by someone not reimbursed through insurance (42 CFR 423.100).
| Cost | Counts toward the cap? | Why |
|---|---|---|
| Deductible you pay on covered Part D drugs | Yes | It is a cost for a covered drug that the plan did not pay |
| Coinsurance or copays you pay on covered drugs | Yes | Same definition of incurred costs |
| Amounts a family member or other person pays for you, if not reimbursed by insurance | Yes | The definition includes costs paid on behalf of the enrollee |
| The share your plan pays | No | The cap counts what is not paid by the plan |
| Your monthly plan premium | No | The definition covers drug costs only, and premiums are billed separately |
| Drugs your plan does not cover | No | Only covered Part D drugs are counted |
Source: 42 CFR 423.100, definition of incurred costs, and 42 CFR 423.104(d)(5), accessed November 12, 2026. Plain-English summary by Personal Touch.
Worked Example: One Brand Drug
For Eliquis, one of the first 10 negotiated drugs, the CMS file lists $237.25 for a 30-day supply starting January 1, 2027, up from $231.00 in 2026 (CMS price file). Our Eliquis answer page covers the drug itself. Here we walk the standard benefit month by month, assuming one 30-day fill each month.
| Month | You pay at the counter | Total paid so far | Step |
|---|---|---|---|
| Jan | $237.25 | $237.25 | Deductible |
| Feb | $237.25 | $474.50 | Deductible |
| Mar | $228.44 | $702.94 | Deductible met, then 25% |
| Apr | $59.31 | $762.25 | 25% coinsurance |
| May | $59.31 | $821.56 | 25% coinsurance |
| Jun | $59.31 | $880.87 | 25% coinsurance |
| Jul | $59.31 | $940.18 | 25% coinsurance |
| Aug | $59.31 | $999.49 | 25% coinsurance |
| Sep | $59.31 | $1,058.80 | 25% coinsurance |
| Oct | $59.31 | $1,118.11 | 25% coinsurance |
| Nov | $59.31 | $1,177.42 | 25% coinsurance |
| Dec | $59.31 | $1,236.73 | 25% coinsurance |
Source: our calculation from the CMS negotiated price file and the CMS CY2027 Rate Announcement ($700 deductible, 25% coinsurance), rounded to the cent. Illustration only; your plan's design and your pharmacy may differ.
The first two months cost the full $237.25. The third crosses the $700 deductible. From month four on each fill is 25% of the price, or $59.31. The year totals $1,236.73, well under the cap. If this were your only brand-name drug you would never reach the $0 step; the cap mainly protects people with several costly drugs or one very expensive one.
Worked Example: Two Brand Drugs
Add a second drug and the picture changes. Farxiga is priced at $183.33 for 30 days in 2027 in the same CMS file. Together the two drugs cost $420.58 a month at the negotiated prices.
| Month | You pay at the counter | Total paid so far | Cap left |
|---|---|---|---|
| Jan | $420.58 | $420.58 | $1,979.42 |
| Feb | $314.71 | $735.29 | $1,664.71 |
| Mar | $105.15 | $840.44 | $1,559.56 |
| Apr | $105.15 | $945.59 | $1,454.41 |
| May | $105.15 | $1,050.74 | $1,349.26 |
| Jun | $105.15 | $1,155.89 | $1,244.11 |
| Jul | $105.15 | $1,261.04 | $1,138.96 |
| Aug | $105.15 | $1,366.19 | $1,033.81 |
| Sep | $105.15 | $1,471.34 | $928.66 |
| Oct | $105.15 | $1,576.49 | $823.51 |
| Nov | $105.15 | $1,681.64 | $718.36 |
| Dec | $105.15 | $1,786.79 | $613.21 |
Source: our calculation from the CMS negotiated price file and the CMS CY2027 Rate Announcement. Illustration only; no premium is included.
The deductible is met in February, and the rest of the year runs at $105.15 a month. The total is $1,786.79, leaving $613.21 of room under the cap. Our Farxiga answer and Januvia answer ($116.06 a month) walk through those drugs the same way.
Taking several brand-name drugs?
Your plan, formulary tiers and pharmacy decide where you land under the cap. Send us the list and we compare the 2027 plans we represent on total yearly cost, not just the premium.
Call or text 208-350-9933 Send us a messageWhen the Cap Is Reached: A High-Cost Drug
To see the cap work, we need a high price. Enbrel (etanercept) is one of the first 10 negotiated drugs, priced at $2,418.70 for 30 days in 2027, up from $2,355.00 in 2026 (CMS price file), and it is not on the CMS list of drugs removed from negotiation (CMS program page). It is a price example, not advice about any medication.
Total you have paid on covered drugs, by month, 2027
Source: our calculation from the CMS negotiated price file and the CMS CY2027 Rate Announcement. Solid line: Enbrel example. Dotted line: Eliquis plus Farxiga. Dashed line: Eliquis alone. Illustration only.
| Month | One drug ($237.25) | Two drugs ($420.58) | Enbrel example ($2,418.70) |
|---|---|---|---|
| Jan | $237.25 | $420.58 | $1,129.68 |
| Feb | $474.50 | $735.29 | $1,734.36 |
| Mar | $702.94 | $840.44 | $2,339.04 |
| Apr | $762.25 | $945.59 | $2,400.00 |
| May | $821.56 | $1,050.74 | $2,400.00 |
| Jun | $880.87 | $1,155.89 | $2,400.00 |
| Jul | $940.18 | $1,261.04 | $2,400.00 |
| Aug | $999.49 | $1,366.19 | $2,400.00 |
| Sep | $1,058.80 | $1,471.34 | $2,400.00 |
| Oct | $1,118.11 | $1,576.49 | $2,400.00 |
| Nov | $1,177.42 | $1,681.64 | $2,400.00 |
| Dec | $1,236.73 | $1,786.79 | $2,400.00 |
Source: our calculation from the CMS negotiated price file and the CMS CY2027 Rate Announcement, rounded to the cent.
January's fill takes the $700 deductible plus 25% of the rest, so the first counter bill is $1,129.68. February and March are $604.68 each. April's fill would be $604.68, but only $60.96 is left under the cap. From May the covered drug costs $0 at the counter, and the year totals exactly $2,400.00. That is a high ceiling for a household budget, and it is what the payment plan is built to soften.
The Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan is a feature every Part D plan, and every Medicare Advantage plan with drug coverage, must offer. You elect it. Once you opt in, you pay $0 at the pharmacy for covered drugs and your plan bills you monthly. The rules are in 42 CFR 423.137; the table pulls out the points we are asked about most.
| Question | What the rule says |
|---|---|
| Who can join? | Any Part D enrollee, including people who get Extra Help |
| When? | Before the plan year starts or any time during the year, including during the fall enrollment period |
| How? | By phone, on paper or online; the plan must accept any of the three |
| How fast? | Within 24 hours of a complete request during the year; within 10 days before the year starts |
| Interest or fees? | None. No late fees, interest or fees for payment methods |
| Which drugs? | All of your covered Part D drugs once you opt in |
| Billing | A separate monthly bill from the premium bill |
| Missed payment? | A grace period of at least two months before you can be removed |
| Next year? | Renews automatically; you can opt out at any time |
| Change plans mid-year? | You must opt in again with the new plan |
Source: 42 CFR 423.137(d) to (g), accessed November 12, 2026. Plain-English summary by Personal Touch.
The plan cannot bill you more than a maximum monthly cap. In your first month it is the yearly threshold, minus costs already incurred, divided by the months left in the year. In later months it is what you still owe plus any new costs, divided by the months left, counting the current month.
A Payment Plan Example, Month by Month
Take the Enbrel example and turn the payment plan on before January 1. The first-month cap is $2,400 divided by 12, or $200.00. You pay $0 at the pharmacy, and your plan bills the lesser of what you incurred or the cap.
| Month | Without the plan (counter) | Monthly cap | Billed with the plan | Still owed after this bill |
|---|---|---|---|---|
| Jan | $1,129.68 | $200.00 | $200.00 | $929.68 |
| Feb | $604.68 | $139.49 | $139.49 | $1,394.87 |
| Mar | $604.68 | $199.96 | $199.96 | $1,799.59 |
| Apr | $60.96 | $206.73 | $206.73 | $1,653.82 |
| May | $0.00 | $206.73 | $206.73 | $1,447.09 |
| Jun | $0.00 | $206.73 | $206.73 | $1,240.36 |
| Jul | $0.00 | $206.73 | $206.73 | $1,033.63 |
| Aug | $0.00 | $206.73 | $206.73 | $826.90 |
| Sep | $0.00 | $206.73 | $206.73 | $620.17 |
| Oct | $0.00 | $206.72 | $206.72 | $413.45 |
| Nov | $0.00 | $206.73 | $206.73 | $206.72 |
| Dec | $0.00 | $206.72 | $206.72 | $0.00 |
| Total | $2,400.00 | $2,400.00 |
Source: our calculation using the maximum monthly cap formula in 42 CFR 423.137(c) and the cost figures in the table above, rounded to the cent. Illustration only; your plan's bill can differ by a few cents.
Without the plan, the biggest single month is $1,129.68. With it, the biggest bill is $206.73. The year-end total is the same, $2,400.00: the same money, on a smoother schedule. The rule also says participation has "no impact on true out-of-pocket cost accumulation," so you reach the $0 step at the same moment (42 CFR 423.137(c)(4)).
Who It Helps, and Who It Does Not
Part D plans must reach out to members likely to benefit: those who incur $600 or more in out-of-pocket costs for a single covered Part D drug, or who incurred $2,000 in the first nine months of the prior year (42 CFR 423.137(e)). Those are good rules of thumb for anyone.
| Your situation | Payment plan fit | Why |
|---|---|---|
| One drug costs you $600 or more out of pocket | Often helps | It turns a large counter bill into smaller monthly bills |
| You spent $2,000 or more in the first nine months of last year | Often helps | Your January bill is likely to be large again |
| Your monthly drug costs are small and steady | Adds little | There is no spike to smooth out |
| You prefer to pay each fill as you go | Optional | You can opt out at any time |
| You want to reduce what you pay in total | Does not help | The total is the same; choosing a better plan or checking Extra Help may matter more |
| You may switch Part D plans mid-year | Plan ahead | You must opt in again with the new plan, and you can repay the balance in a lump sum |
Source: outreach criteria from 42 CFR 423.137(e)(1); fit guidance by Personal Touch, not a CMS list.
Idaho Part D Plans for 2027
CMS lists 8 standalone prescription drug plans for Idaho in 2027, 4 basic and 4 enhanced. Premiums run from $5.30 to $238 a month, and 5 use the full $700 deductible (CMS CY2027 Landscape file). The premium is billed separately and is not part of the cap.
| Plan | Type | Monthly premium | Deductible |
|---|---|---|---|
| Wellcare Value Script (PDP) | Enhanced | $5.30 | $700 |
| Wellcare Classic (PDP) | Basic | $7.30 | $700 |
| Humana Basic Rx Plan (PDP) | Basic | $30.60 | $700 |
| Humana Value Rx Plan (PDP) | Enhanced | $34.70 | $687 |
| AARP Medicare Rx Saver from UHC (PDP) | Basic | $92.70 | $700 |
| HealthSpring Assurance Rx (PDP) | Basic | $94.80 | $700 |
| Humana Premier Rx Plan (PDP) | Enhanced | $134 | $350 |
| AARP Medicare Rx Preferred from UHC (PDP) | Enhanced | $238 | $300 |
Source: CMS CY2027 Medicare Advantage and Part D Landscape file (202610), Idaho standalone plans, accessed November 12, 2026. Sorted by premium. Personal Touch represents a defined set of carriers; see the disclaimer in the page footer.
A low premium does not mean a low yearly cost. The formulary, the tier a drug sits on and the preferred pharmacies decide how fast you reach the 25% step and the cap. Advantage plans with drug coverage follow the same cap and also offer the payment plan; see our Part D service page and Learning Center guide.
Extra Help Copayments in 2027
Extra Help, the Part D low-income subsidy, lowers costs for members who qualify. Members with a full subsidy pay no deductible and capped copays. CMS published the 2027 maximums in the Rate Announcement.
| Extra Help category | Drug type | 2026 | 2027 |
|---|---|---|---|
| Full-benefit dual eligible, income up to 100% of the federal poverty level | Generic or preferred multi-source | $1.60 | $1.65 |
| Full-benefit dual eligible, income up to 100% of the federal poverty level | Other drugs | $4.90 | $5.00 |
| Income between 100% and 150% of the poverty level, and full subsidy members who are not full-benefit dual eligible | Generic or preferred multi-source | $5.10 | $5.80 |
| Same group as above | Other drugs | $12.65 | $14.40 |
| Institutionalized full-benefit dual eligible members | All covered drugs | $0.00 | $0.00 |
Source: CMS CY2027 Rate Announcement, Attachment V, Table V-2, accessed November 12, 2026. Eligibility rules and resource limits are set separately by CMS each year.
The payment plan is open to Extra Help members too (42 CFR 423.137(d)), but with copays this small it rarely changes much. If you might qualify, ask us to review it with you.
What to Watch This Fall
- The enrollment deadline. The Annual Enrollment Period ends December 7, 2026 for coverage that starts January 1. Our answer on when you can change your Medicare plan covers the other windows.
- Drugs leaving the negotiation list. CMS lists Xarelto, Entresto, Stelara and NovoLog among drugs removed from the Selected Drug List effective January 1, 2027, so their negotiated prices no longer apply (CMS program page). Our Xarelto answer explains what that means.
- 2027 Part B figures. CMS has not yet published the 2027 Part B premium and deductible, so we label them pending and will refresh when they arrive.
How We Built This Page
The $700 deductible, the $2,400 threshold and the Extra Help copays come from Attachment V of the CMS CY2027 Rate Announcement. Negotiated prices come from the CMS price file dated September 21, 2026 (rows effective January 1, 2027), checked against the deselection list on the CMS program page. Idaho plan data comes from the CMS CY2027 Landscape file, and the payment plan and incurred-cost rules from 42 CFR 423.137 and 423.100, read November 12, 2026.
Every cost table is our own arithmetic: one 30-day fill a month at the negotiated price, a plan that follows the standard benefit, no premium, rounded to the cent. Real plans may use copays, tiers and preferred pharmacies that change the result. We have not read any plan's Evidence of Coverage or formulary for this page. The examples are not a prediction of any person's costs and not medical or medication advice. Figures are a snapshot dated November 12, 2026. Personal Touch Ins. & Benefits, LLC represents a defined set of carriers and plans, and compares the ones it represents with you.
Want your own prescriptions priced against the 2027 cap?
Send us your drug list with doses and your pharmacy. We price the Part D and Medicare Advantage plans we represent, show you the month-by-month picture, and tell you plainly whether the payment plan is worth turning on. We meet by Zoom, phone or in Idaho City by appointment.
Call or text 208-350-9933 Send us a messageFrequently Asked Questions
What is the Part D out-of-pocket cap in 2027?
The annual out-of-pocket threshold in the 2027 defined standard Part D benefit is $2,400, up from $2,100 in 2026 (CMS CY2027 Rate Announcement). Once you have paid that much for covered Part D drugs in the year, covered drugs cost $0 for the rest of the year. The deductible is $700 and you pay 25% between the deductible and the cap. Many plans use copays that work out to the same average, so your plan can differ. Our licensed agents at Personal Touch compare this for you at no cost: call or text 208-350-9933.
Does my Part D premium count toward the $2,400?
No. The cap is built from what you pay for covered Part D drugs, which federal rules call incurred costs (42 CFR 423.100). A monthly plan premium is not a drug cost, so it is paid in addition to the cap. The Medicare Prescription Payment Plan bill is also separate from the premium bill (42 CFR 423.137). We add up all of your monthly bills with you before you choose.
What is the Medicare Prescription Payment Plan?
It is a way to pay your Part D drug costs in monthly amounts across the year instead of at the pharmacy counter. Every Part D plan must offer it to every enrollee (42 CFR 423.137). You pay $0 at the pharmacy for covered drugs and the plan bills you each month. It spreads your costs out. It does not lower them. We can help you decide whether to turn it on.
Does the payment plan charge interest or fees?
No. Federal rules say a Part D plan must not charge late fees, interest or other fees on the Medicare Prescription Payment Plan (42 CFR 423.137). If you miss a payment, the plan must give you a grace period of at least two months before ending your participation. Even then, the plan cannot demand the whole balance at once. If a bill worries you, call us at 208-350-9933.
Will the payment plan save me money?
No. Your total for the year is the same. The plan only changes when you pay. In our 2027 example for a drug priced at $2,418.70 a month, you owe $2,400 either way, but the monthly bills top out near $207 instead of a $1,129.68 bill in the first month. It helps with cash flow, so it fits people who have a large bill in a single month. We look at your drug list and tell you plainly whether it helps.
When can I join the payment plan, and does it continue next year?
You can join before the plan year starts or at any point during the year, by phone, on paper or online (42 CFR 423.137). The plan must process a request within 24 hours during the year. Participation renews automatically for the next plan year, and you can opt out at any time. If you change Part D plans, you must opt in again with the new plan. We remind our clients about this when we help them switch.
Keep Reading
Sources
- CMS, CY2027 Medicare Advantage and Part D Rate Announcement (Attachment V: Part D benefit parameters and Extra Help copayments), accessed November 12, 2026
- 42 CFR 423.137, Medicare Prescription Payment Plan (Electronic Code of Federal Regulations), accessed November 12, 2026
- 42 CFR 423.100, Part D definitions, including incurred costs, accessed November 12, 2026
- 42 CFR 423.104, Part D benefits, including the annual out-of-pocket threshold, accessed November 12, 2026
- CMS, Selected Drug List and Maximum Fair Price data file (ZIP, file dated September 21, 2026), accessed November 12, 2026
- CMS, Medicare Drug Price Negotiation Program: selected drugs and negotiated prices, accessed November 12, 2026
- CMS CY2027 Medicare Advantage and Part D Landscape file (202610), Idaho standalone Part D plans, accessed November 12, 2026
- CMS, Final CY 2026 Part D Redesign Program Instructions, accessed November 12, 2026
Figures are labelled with the year they apply to and were checked against the official sources above on the date shown. This page is general education, not individual advice. Personal Touch Ins. & Benefits, LLC is not connected with or endorsed by the U.S. government or the federal Medicare program.