The season’s news
Medicare in 2027: the drug cap rises, Ozempic gets negotiated, and premiums held steadier than expected
Short answer: 2027 brings real change on the drug side, and as of September 28 the plan-price picture is finally public. The out-of-pocket cap rises to $2,400 and the standard deductible to $700; negotiated prices for 15 more drugs (led by Ozempic, Wegovy, and Rybelsus at $274 a month) start January 1. On premiums, CMS projects the average Medicare Advantage premium falling 16.5% and the average standalone drug plan premium rising by less than a dollar, which is milder than many expected when the federal stabilization program was set to end. Part B’s premium is still pending. Here is everything, sorted by what’s final and what it means for your own re-shop.
Key takeaways
- Final: the Part D out-of-pocket cap rises to $2,400 (from $2,100), the standard deductible to $700 (from $615), the base premium to $41.33.
- Final: negotiated prices on 15 more drugs start January 1, including the semaglutide family (Ozempic, Wegovy, Rybelsus) at $274 for 30 days, 71% off list.
- New, September 28: CMS projects average MA premiums down 16.5% ($14.37 to $12.00) and average standalone drug plan premiums up less than $1 ($35.09 to $36).
- Averages are not your plan: CMS says roughly 8 in 10 Advantage members can keep their current plan at the same or lower premium, which leaves 2 in 10 who cannot.
- Still pending: the 2027 Part B premium and the Part A and B deductibles, announced in late October or November.
The drug numbers, all final
| Part D parameter | 2026 | 2027 | Change |
|---|---|---|---|
| Out-of-pocket cap on covered drugs | $2,100 | $2,400 | +$300 |
| Standard deductible (maximum) | $615 | $700 | +$85 |
| National base premium | $38.99 | $41.33 | +$2.34 (the 6% legal maximum) |
| Insulin, per month’s supply | $35 | $35 | none |
| ACIP-recommended vaccines | $0 | $0 | none |
Per the CMS CY2027 Rate Announcement and the July 2026 Part D bid announcement. Individual plans vary beneath these ceilings.
The ceiling protecting heavy prescription users rises $300; the deductible everyone crosses first rises $85. The base premium’s $2.34 increase hit the Inflation Reduction Act’s 6% annual cap exactly, and it matters beyond premiums: it sets the Part D late penalty and the Part D IRMAA surcharges.
What CMS announced on September 28
Two weeks before open enrollment, CMS published its annual look at what plans will actually charge. The headline numbers:
| Plan type | 2026 average | 2027 projection | Change |
|---|---|---|---|
| Medicare Advantage, all plans | $14.37/month | $12.00/month | down 16.5% |
| Drug coverage inside Advantage plans (after rebates) | $11.32/month | $7.00/month | down 38% |
| Standalone Part D drug plans | $35.09/month | $36.00/month | up less than $1 |
| Advantage plans available nationally | 5,553 | about 5,532 | essentially flat |
| Beneficiaries with 10 or more Advantage choices | not stated | 97% | broad access continues |
CMS press release, September 28, 2026. These are weighted national averages and projections, not the price of any particular plan.
A correction worth making plainly. Through the summer, a widely repeated expectation (ours included) was that standalone drug plan premiums would jump once the federal Part D Premium Stabilization Demonstration ended December 31. CMS now projects the average standalone premium rising by less than a dollar, and the agency pushed back directly on what it called speculation and misleading reports about the demonstration’s sunset, describing broad pricing stability across the Part D market. The honest read: the average held. That is good news, and it does not mean every plan held, which is the distinction the rest of this article is about.
The negotiated 15, led by semaglutide
January 1 activates round two of Medicare drug price negotiation: 15 more drugs, together about $42.5 billion of Part D spending in 2024, used by 5.3 million people. The headline is the semaglutide family, with Ozempic, Rybelsus, and Wegovy at $274 for a 30-day supply, 71% below the $959 list price. The list also includes Trelegy Ellipta, Xtandi, Pomalyst, Ibrance, Ofev, Austedo, and Janumet, at discounts running 38% to 85%. What you pay at the counter still flows through your plan’s tiers and phases, but lower negotiated prices mean you cross the deductible and approach the $2,400 cap on lower totals. Details, including how weight-loss prescriptions differ, are in the semaglutide article.
Still pending: the Part B side
The 2027 Part B premium (2026: $202.90) and the Part A and B deductibles arrive in CMS’s late-October or November announcement, with the 2027 IRMAA brackets. The 2026 Trustees Report projected $209.50 a month, a far smaller rise than 2026’s 9.7% jump, but a projection is not a premium and we won’t treat it as one. The real figures go into the premiums tracker and the numbers page within days of release.
What the averages mean for your own plan
A national average is a weighted summary of thousands of plans; your plan is one of them. CMS’s own framing makes the point: roughly eight in ten Advantage members can stay in their current plan at the same or a lower premium for 2027. That is reassuring for most people and useless for the other two in ten, who have no way to know which group they are in except by looking. Three things the averages cannot tell you:
- Your formulary. Premiums are the least of it; a drug moving tiers can cost more than a premium change saves. Run your exact list through the Plan Finder method.
- Your network. Advantage networks reset in January, and a departing doctor is the most expensive change a plan can make to you. Verify by phone, as the comparison checklist describes.
- Your deductible and ceiling. A plan can cut its premium and raise its deductible toward the new $700 maximum, or raise its out-of-pocket max. Your Annual Notice of Change shows both.
The practical conclusion for the season: less alarm than the summer coverage suggested, and the same thirty minutes of homework. The open enrollment page has the dates, the plan, and a free printable checklist.
Questions people also ask
What is the Medicare Part D out-of-pocket cap for 2027?
Are Medicare drug plan premiums going up in 2027?
Are Medicare Advantage premiums going down in 2027?
What will Ozempic cost on Medicare in 2027?
Has the 2027 Part B premium been announced?
Sources for this article
- CMS.gov2027 Medicare Advantage and Part D landscape announcement (September 28, 2026): the premium projections and plan-availability figures.
- CMS.gov2027 Part D bid announcement: the $41.33 base premium and the stabilization demonstration’s end.
- Medicare.govPart D costs: the deductible, out-of-pocket cap, and smoothing rules.
Figures checked against these sources on September 30, 2026. We update within days when CMS publishes new amounts.
Not sure which path fits you? Get a straight answer.
Start the decoderThe one paid thing
Stop re-reading Medicare articles. Decide, on paper, in two evenings.
The Turning-65 Decision Workbook is this site’s free explanations turned into pages you fill in, so the decision ends up written down instead of rattling around in your head.
- Your enrollment dates calculated from your own birthday, with the penalty deadlines marked
- Advantage vs. Medigap scored against your doctors, drugs, travel, and budget
- Word-for-word scripts for the broker, HR, the pharmacy, and Social Security
- The September re-shop ritual you reuse every fall, with the 2026 and 2027 numbers card
Instant PDF download. Free update when the remaining 2027 figures land. Full refund within 30 days if it doesn’t help, and you keep the PDF.