Quick answers
- What is the Part D out-of-pocket cap for 2027?
- $2,400, up from $2,100 in 2026. Once your out-of-pocket costs for covered drugs reach the cap, you pay nothing more for covered Part D drugs for the rest of the year.
- How many stand-alone Part D plans are in Oregon for 2027?
- CMS's 2027 data lists 8 stand-alone Part D plans in Oregon from 4 companies. Oregon and Washington form one Part D region, so the same stand-alone plans are offered statewide.
- Is there still a donut hole?
- No. The coverage gap ended in 2025. Part D now has a deductible, an initial coverage phase, and catastrophic coverage after you reach the yearly cap.
- What does insulin cost with Part D?
- No more than $35 for a month's supply of each covered insulin, and the deductible doesn't apply.
- Can I spread my drug costs over the year?
- Yes. Every Part D plan offers the Medicare Prescription Payment Plan, which lets you pay your out-of-pocket drug costs in monthly amounts instead of at the pharmacy. It costs nothing to join and doesn't lower your total costs.
Medicare Part D is prescription drug coverage sold by private companies approved by Medicare. You can get it two ways: a stand-alone Part D plan (PDP) that you add to Original Medicare, or a Medicare Advantage plan with drug coverage (MA-PD). Open Enrollment for 2027 coverage runs October 15 to December 7, 2026, and the 2027 cap on what you pay for covered drugs rises to $2,400.
How Part D works in 2027
| Part D, set by Medicare | 2026 | 2027 |
|---|---|---|
| Yearly out-of-pocket cap for covered drugs | $2,100 | $2,400 |
| Highest deductible a plan may set | $615 | $700 |
| Covered insulin, per month's supply | $35 at most | $35 at most |
| National base beneficiary premium (used for the late penalty) | $38.99 | $41.33 |
Each plan sets its own premium, deductible (up to the maximum), formulary, tiers and pharmacy network. Recommended adult vaccines, such as the shingles vaccine, cost nothing under Part D.
The three phases (no more donut hole)
| Phase | What you pay |
|---|---|
| Deductible, if your plan has one (up to $700 in 2027) | The plan's negotiated price for your drugs until you meet the deductible |
| Initial coverage | The plan's copayment or coinsurance for each drug, until your out-of-pocket costs reach the cap |
| Catastrophic coverage (after $2,400 out of pocket in 2027) | $0 for covered Part D drugs for the rest of the year |
The coverage gap, or "donut hole," ended in 2025. See what happened to the donut hole and the 2027 out-of-pocket cap.
Formularies, tiers and pharmacies
Each Part D plan has a formulary, its list of covered drugs, usually grouped into tiers, with lower costs for generics and preferred drugs and higher costs for specialty drugs. Two plans can both cover the same drug but put it on different tiers or require prior authorization, so your yearly cost can differ a lot. Plans can also have preferred pharmacies with lower costs, which matters if your nearest pharmacy in rural Oregon isn't preferred, and most plans offer mail order.
Before you choose, enter your exact drugs, doses and pharmacy in a plan finder. Check your drugs against Oregon plans on PlanMatch or use Medicare.gov's Plan Finder. Plans change formularies and costs every year, so read your Annual Notice of Change, which arrives by September 30. See our Oregon drug coverage guides for common drugs.
Medicare drug price negotiation
Under the Inflation Reduction Act, Medicare negotiates prices for some high-cost drugs:
- 2026: negotiated prices for the first 10 drugs took effect January 1, 2026.
- 2027: CMS reached agreements on 15 more Part D drugs, including Ozempic, with prices that take effect January 1, 2027.
- 2028: in January 2026 CMS selected 15 more drugs, including the first Part B drugs, for prices starting January 1, 2028.
A negotiated price lowers what Medicare plans pay; what you pay still depends on your plan's tier, deductible and the yearly cap. The full lists are on CMS.gov.
The Medicare Prescription Payment Plan
Every Part D plan and Medicare Advantage plan with drug coverage must offer the Medicare Prescription Payment Plan. Instead of paying at the pharmacy, you get a monthly bill from your plan that spreads your out-of-pocket drug costs over the rest of the year. It costs nothing to join and doesn't lower your total costs; it helps most if you have high drug costs early in the year. Contact your plan to sign up. See what is the Medicare Prescription Payment Plan?
Part D plans in Oregon for 2027
Oregon and Washington together form Part D region 30, so stand-alone Part D plans are offered region-wide: the same plans are available in Portland, Pendleton and Gold Beach. For 2027, CMS lists 8 stand-alone Part D plans in Oregon from 4 companies. Medicare Advantage plans with drug coverage are offered county by county; see Medicare Advantage in Oregon and your county.
That matters most in Grant, Harney, Lake, Umatilla and Union counties, which have no Medicare Advantage plan open to everyone for 2027: there, people with Medicare get drug coverage from a stand-alone Part D plan, employer or retiree coverage, VA, TRICARE, or a tribal or IHS pharmacy program.
Federal law, not Oregon law, sets Part D rules. Oregon's Division of Financial Regulation regulates Medigap and other insurance sold in the state, but CMS regulates Part D plans. For a problem with a Part D plan, call the plan, then 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). See Medicare appeals in Oregon.
Extra Help and the Oregon Health Plan
Extra Help, the federal Low-Income Subsidy, lowers Part D premiums and deductibles and limits copayments, for 2027 to no more than $5.80 for a generic and $14.40 for a brand-name drug (less for some people with Medicaid). Since 2024, full Extra Help covers people with income up to 150% of the federal poverty level who meet the resource limit.
- If you have both Medicare and the Oregon Health Plan, a Medicare Savings Program, or SSI, you get Extra Help automatically. Most OHP members with Medicare have "OHP with Limited Drug," which means Part D, not OHP, covers their drugs, and OHP doesn't pay Part D premiums or copayments (Oregon Health Authority).
- Otherwise, apply through Social Security at ssa.gov/extrahelp or 1-800-772-1213.
- People with Medicaid or Extra Help can change Part D plans once a month.
Read Extra Help in Oregon and how to get Extra Help in Oregon.
Part D late enrollment penalty
If you go 63 days or more in a row without Part D or other creditable drug coverage after your Initial Enrollment Period, Medicare adds 1% of the national base beneficiary premium ($41.33 in 2027) to your premium for each full month you went without. For example, 24 months without coverage adds about $9.92 a month in 2027. The penalty generally lasts as long as you have Part D. You won't owe it if you get Extra Help.
Creditable coverage includes most job-based drug coverage, VA and TRICARE. Employers must tell you each year whether their coverage is creditable; keep the notices. See Part D creditable coverage in Oregon and the Part D penalty calculator.
When to enroll in Part D
- Initial Enrollment Period: the 7 months that start 3 months before the month you turn 65.
- Open Enrollment: October 15 to December 7 each year, to join, switch or drop a plan for January 1.
- Medicare Advantage Open Enrollment Period: January 1 to March 31, if you're in a Medicare Advantage plan, you can switch plans or go back to Original Medicare and join a stand-alone Part D plan.
- Special Enrollment Periods: for example, when you move, lose job-based drug coverage, get Extra Help or Medicaid, or your plan leaves your area.
To compare Part D plans from the companies they work with against your prescriptions, you can request a call from a licensed insurance agent.
Related questions
- What is the Part D out-of-pocket cap for 2027?
- Does Medicare cover insulin in Oregon?
- Does Medicare cover weight loss drugs in Oregon?
- Can I use the ArrayRx discount card with Medicare?
Sources
- Medicare.gov — Drug coverage (Part D)
- Medicare.gov — What Medicare drug plans cover
- Medicare.gov — Prescription drugs (outpatient) under Part B
- Medicare.gov — Medicare Prescription Payment Plan
- Medicare.gov — Avoid late enrollment penalties
- Medicare.gov — Special Enrollment Periods
- CMS — CY2027 rate announcement (Part D benefit parameters)
- CMS — Negotiated prices for initial price applicability year 2027 (fact sheet)
- CMS — Selection of drugs for the third cycle of negotiation, including the first Part B drugs (January 2026)
- CMS — Medicare Advantage and Part D contract and enrollment data (CY2027 Landscape, Oregon stand-alone Part D plans)
- CMS — Part D public use file record layout (PDP region 30: Oregon, Washington)
- Social Security Administration — Extra Help with Medicare prescription drug plan costs
- Oregon Health Authority — OHP and Medicare (OHP with Limited Drug)
Every question in this guide
- Can I use the Oregon ArrayRx discount card with Medicare?
- How much is insulin with Medicare in Oregon?
- Does Medicare cover Ozempic, Wegovy, or other weight-loss drugs in Oregon?
- What is the Medicare Prescription Payment Plan?
- Is there still a Medicare Part D donut hole in 2026?
- What is the Medicare Part D out-of-pocket cap for 2027?
Frequently asked questions
What drugs does Medicare Part D cover?
Each Part D plan has its own formulary (list of covered drugs), but every plan must cover a wide range of drugs, including most drugs in protected classes such as cancer, HIV/AIDS and depression drugs, and recommended adult vaccines at no cost. Plans can use tiers, prior authorization and quantity limits. Federal law excludes some drugs, such as drugs used only for weight loss, cosmetic purposes or hair growth.
Which drugs have Medicare negotiated prices?
Negotiated prices for the first 10 drugs took effect January 1, 2026. CMS reached agreements on 15 more Part D drugs, including Ozempic, with prices that take effect January 1, 2027. In January 2026 CMS selected 15 more drugs, including the first Part B drugs, for prices starting in 2028. CMS publishes the full lists on CMS.gov.
Does Medicare Part B cover any prescription drugs?
Yes. Part B covers drugs you usually don't give yourself, such as many infusions and injections given in a doctor's office or clinic (for example, eye injections like Eylea or Lucentis), some oral cancer drugs, drugs used with durable medical equipment, and certain vaccines. Most drugs you pick up at a pharmacy are covered by Part D.
Is the Part D out-of-pocket cap the same in every plan?
Yes. The cap ($2,400 in 2027) applies to covered drugs in every Part D plan and every Medicare Advantage plan with drug coverage. Premiums and drugs not on your plan's formulary don't count toward it.
Can I get help paying for Part D in Oregon?
Yes. Extra Help, the federal Low-Income Subsidy, lowers Part D premiums, deductibles and copayments for people with limited income and resources. People with OHP, a Medicare Savings Program or SSI get it automatically; others can apply through Social Security.
Do I need Part D if I have VA, TRICARE or employer drug coverage?
Not if that coverage is creditable, meaning expected to pay at least as much as standard Part D. VA and TRICARE drug coverage are creditable, and employers must tell you each year whether theirs is. Keep those notices; you'll need them to avoid a penalty if you join Part D later. Oregon PERS retiree (PHIP) Medicare plans already include a Part D plan.
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