2027 Medicare Part D plans face higher premiums and cost caps

During the current Medicare open enrollment window, beneficiaries can choose from 28 Medicare Advantage prescription drug plans (MA-PDs) and nine stand-alone prescription drug plans (PDPs) in the voluntary Part D program.

The annual out-of-pocket limit for Part D, now a standard feature of the benefit, is projected to rise to $2,400 in 2027 from $2,100 in 2026. The cap includes prescription drugs covered by the plan, including specialty medications, along with deductibles, copays and coinsurance. It does not cover drugs excluded from Part D, drugs paid under Medicare Part B, manufacturer discounts or monthly plan premiums.

Premiums are also expected to move higher. A recent KFF analysis estimates that enrollment-weighted average monthly premiums for PDPs will increase to $51 in 2027 from $34 in 2026, a jump of about 50% if current members stay in the same plans. MA-PDs are projected to see only a smaller increase, widening the premium gap between the two plan types to more than five times.

Average weighted deductibles for 2027 are forecast at $643 for PDP enrollees and $489 for MA-PD enrollees. In percentage terms, the increase is steeper for MA-PD members, at 36%, compared with 19% for PDP enrollees.

Cost sharing is also shifting more toward coinsurance than fixed copayments, which could make out-of-pocket spending less predictable for beneficiaries. According to the KFF analysis, the median standard cost sharing across Part D plans for 2027 is expected to be:

• Generics: Preferred generics carry copays of $4 in PDPs and $0 in MA-PDs. Other generics carry copays of $20 in PDPs and $5 in MA-PDs.

• Preferred brands: Nearly all PDP enrollees face a median coinsurance rate of 25%. Among MA-PD enrollees, 83% face 20% coinsurance, while 17% have a median copay of $47.

• Non-preferred drugs: For drugs in this category, which includes both brands and generics, all PDP enrollees face a median coinsurance rate of 35%. For MA-PD enrollees, 89% face a median coinsurance rate of 29%, while 11% face a median copay of $100.

• Specialty drugs: The median coinsurance rate for specialty medications is 25% for PDP enrollees and 26% for MA-PD enrollees.

Additional information on Medicare Part D changes and what they could mean for patient support, reimbursement and trade strategy is available in person.