What the donut hole was
From 2006 through 2024, Part D had four stages. After the deductible and initial coverage, many people reached the coverage gap, nicknamed the donut hole, where they paid a larger share of drug costs until their spending reached the catastrophic threshold. The Affordable Care Act shrank the gap over time, but people on expensive drugs could still pay thousands of dollars a year, with no upper limit.
How Part D works in 2026
| Stage | What you pay (2026) |
|---|---|
| Deductible | Full cost of covered drugs until you reach your plan's deductible, no more than $615. Some plans have a lower deductible or none. |
| Initial coverage | Your plan's copays or coinsurance |
| Catastrophic coverage | Nothing for covered drugs, once your out-of-pocket costs reach $2,100 |
The cap applies to every Part D plan and every Medicare Advantage plan with drug coverage in Oregon. What counts toward it includes your deductible, copays and coinsurance for covered drugs, and amounts others pay for you, such as Extra Help.
Spreading costs over the year
If you'd reach the cap early in the year, the Medicare Prescription Payment Plan lets you pay your drug costs in monthly bills from your plan instead of all at the pharmacy. It doesn't lower your total cost. Every Part D and Medicare Advantage drug plan offers it; you join by contacting your plan.
Part D in Oregon
Oregon and Washington form Part D region 30. For 2027, 8 standalone Part D plans from 4 companies are offered statewide, and most Medicare Advantage plans include drug coverage. Plans differ in premiums, deductibles, formularies and pharmacy networks, so compare them each fall. You can check your drugs on Medicare.gov's Plan Finder, at PlanMatch, or request a call from a licensed insurance agent. If your income is limited, Extra Help lowers drug costs further.
Related questions
What is the Part D out-of-pocket cap for 2027?
Next year's limit and deductible.
What is the Medicare Prescription Payment Plan?
Monthly bills instead of big pharmacy costs.
How much is insulin with Medicare?
The monthly insulin limit.
Sources
- Medicare.gov — How much does Medicare drug coverage cost?
- Medicare.gov — Medicare Prescription Payment Plan
- CMS — Prescription drug coverage
- CMS — Medicare Advantage/Part D contract and enrollment data (CY2027 Landscape)
More questions 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?
- What is the Medicare Part D out-of-pocket cap for 2027?
Part of the guide: Medicare Part D in Oregon — 2027 drug coverage · All questions
Frequently asked questions
Do drugs my plan doesn't cover count toward the cap?
No. Only drugs on your plan's formulary, or drugs covered through an approved exception or appeal, count toward the out-of-pocket cap.
How does insulin fit in?
Each covered insulin costs no more than $35 for a month's supply, with no deductible. What you pay for insulin also counts toward the yearly cap.
Will the cap stay the same in 2027?
No. It rises each year with Part D costs. For 2027 CMS set it at a higher amount; see our page on the 2027 out-of-pocket cap.
Medicare in your Oregon county
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