October 29, 2026 - KFF Answers Medicare Questions:

I heard there have been changes to Medicare in recent years to help beneficiaries lower their out-of-pocket prescription drug costs or spread them throughout the year. How can these changes help me?

Yes, changes have been made in recent years to improve the Part D benefit. In 2027, your annual Part D out-of-pocket costs will be capped at $2,400. Also, cost sharing for insulin is now capped at $35 per month per prescription, and you no longer have to pay any cost sharing for adult vaccines covered by your Part D plan, such as the vaccine for shingles.

All Medicare Part D plans are also now required to offer enrollees the option to pay for their out-of-pocket drug costs in the form of monthly payments over the course of the year instead of upfront at the pharmacy. You can opt into this payment option, known as the Medicare Prescription Payment Plan, by contacting your plan at any time. When you fill a prescription at the pharmacy, you won’t pay the pharmacy; instead, your drug plan will send you a bill each month. The payment option may make high drug costs easier to manage, but it does not reduce your total drug costs. All prescription drug plans will offer this payment option, but participation is voluntary.  For more information, you can call your drug plan or visit their website. You can also find more information by contacting your State Health Insurance Assistance Program (SHIP). SHIPs offer local, personalized counseling and assistance to people with Medicare and their families. You can call 877-839-2675 to get the phone number for the SHIP in your state.

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While every effort has been made to provide accurate and up-to-date information in these FAQs, people should contact Medicare, Social Security, State Health Insurance Assistance Programs (SHIP), or companies offering Medicare Advantage and Medicare Part D plans and Medigap policies directly for guidance on individual circumstances.

Source: KFF