ArcaMax

Toni:

Last year, I emailed you a problem I was having with the premium for my stand-alone Part D plan, and for 2027 there is an increase, though not as high as it was for 2026. The plan is going up by $16.60 per month, from $94.80 in 2026 to $111.40 for the new 2027 Part D plan, which begins Jan. 1. On the positive side, the Part D plan notified me that my heart and rheumatoid arthritis prescriptions will be covered as they were for 2026.

Also, my cardiologist’s office informed me that Medicare has added about 15 expensive prescriptions for 2027. Can you advise what these prescriptions are and address the changes in the 2027 Medicare Part D plan before Medicare’s Open Enrollment Period starts on Oct. 15?

—Tammy from Cypress, Texas

Tammy:

Glad to help you understand what the 2027 Medicare Part D changes are and learn which 15 selected brand-name medications will have a percentage discount. The 2027 Part D and Medicare Advantage Prescription Drug (MAPD) plans became available to the public at www.medicare.gov on Thursday, Oct. 1. Medicare.gov is where to go to find a Medicare Part D or MAPD plan that is affordable and covers your current prescription drugs.

Beginning Jan. 1, 2027, there are 15 brand-name medications that will receive a discount for 2027, and these will be added to the 10 brand-name medications list from 2026, which also continue to receive a discount. The 2026 brand-name list is Eliquis, Xarelto, Januvia, Jardiance, Farxiga, Entresto, Enbrel, Imbruvica, Stelara and NovoLog/Fiasp (insulin aspart). The 2027 list of 15 brand-name medications consists of Janumet, Breo Ellipta, Tradjenta, Linzess, Trelegy Ellipta, Ozempic/Rybelsus/Wegovy, Otezla/XR, Xifaxan, Pomalyst, Ibrance, Ofev, Xrandi, Vraylar, Calquence and Austedo/XR. Medicare negotiated directly with manufacturers to reduce the price of these expensive brand-name Part D prescriptions, and the change will be effective Friday, Jan. 1, 2027. It is important to visit www.medicare.gov to discover which Medicare Part D or MAPD plan covers your prescriptions.

For 2027, Medicare Part D will have three main stages: deductible, initial coverage and catastrophic coverage. Costs and maximum out-of-pocket are as follows:

—Initial deductible is $700.

—Insulin is capped at $35 per month with no deductible, and most adult Part D vaccines are covered with no deductible. In other words, your payments don’t count toward your $700.

—The 6 Drug Tiers of Initial Coverage are as follows: Drug Tier 1: Preferred Generic; Drug Tier 2: Preferred Brand; Drug Tier 3: Non-Preferred Drugs; Drug Tier 4: Injectable Drugs; Drug Tier 5: Specialty Tier; and Drug Tier 6: Select Care Drugs.

—Initial Coverage Stage: During the initial coverage period with the six drug tiers, the Part D plan pays its share of the cost of your drugs, and you pay your share of the cost until the maximum amount of $2,400 out-of-pocket is met. Then you will move to the catastrophic coverage stage.

—Catastrophic coverage: There is a $0 out-of-pocket when a Medicare beneficiary enters the catastrophic coverage stage. The Part D insurer pays 60% of the cost of prescriptions, and Medicare pays 40% of the prescriptions, whether brand-name or generic, with a stand-alone Medicare Part D or MAPD plan. You will pay $0.

—On Jan. 1 of each year, the process starts all over again with a new Medicare Prescription Drug plan and a new initial deductible and maximum initial coverage limit that leads you to the catastrophic coverage stage.

The Medicare Prescription Payment Plan is a payment option that began Jan. 1, 2025, to help manage your out-of-pocket drug costs by spreading your monthly prescription drug costs throughout the year from January to December. For more information about the payment plan, visit www.medicare.gov or call your Medicare Part D plan.

Next week’s article will be about the October 2 termination letters for Medicare Advantage plans, which are leaving a number of states. Those with such plans should be on the alert in case of a notice.

Remember … with Medicare, what you don’t know WILL hurt you!

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Toni King is an author and columnist on Medicare, Social Security and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.

©2026 Toni King. Distributed by Tribune Content Agency, LLC.

Copyright 2026 Toni King, Distributed by Counterpoint Media