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President Trump says drug prices are coming down. But if you’re on Medicare, don’t expect to see it in your 2027 drug plan.
The latest announcement, on Sept. 18, wasn’t about Medicare at all. It was about Medicaid, the separate, state-run program for people with low incomes. The White House says all 50 state Medicaid programs will get “most favored nation” pricing, tying what they pay for drugs to prices in other wealthy countries. (1)
Medicare, the federal program for people 65 and older, is a different story. For 2027, a Part D drug plan can charge a deductible of up to $700, up from $615. The yearly cap on what you pay out of pocket rises to $2,400, from $2,100. (2)(3)
And a federal subsidy that’s been holding down premiums for stand-alone Medicare drug plans ends after this year. (4)
I’ve been a CPA since 1981. When someone announces billions in savings, I ask one question: whose checking account does the money actually land in? For people on Medicare, the answer this time is mostly: not yours.
So let’s sort out what’s real, what’s changing in your Medicare drug coverage and what to do about it — starting with the letter that should already be sitting on your kitchen counter.
1. The Medicaid deal isn’t aimed at Medicare enrollees
Don’t confuse the two programs. The White House pegs the Medicaid savings at $64.3 billion over 10 years, and most of it goes to government budgets: $36.6 billion to Washington and $27.6 billion to the states. (1)
Medicaid patients typically pay copays of just a few dollars already, so even their pharmacy bills may barely change. The Associated Press also notes the terms of the drug company deals haven’t been made public. (5)
For people on Medicare, the deal does nothing directly.
The White House does point to two things that can reach individuals. It says buyers on its TrumpRx.gov site have saved more than $700 million since the site launched in February. (1)
It also says 600,000 Medicare enrollees saved $216 million in two months by getting GLP-1 drugs for $50 a month. (1) If you take one, ask your plan how that price applies to you.
2. What’s changing in your 2027 Medicare Part D
Here’s what matters for your wallet. The maximum deductible jumps $85, to $700. (2)
The out-of-pocket cap climbs $300, to $2,400. Once your covered drug costs hit that level, you owe nothing more for covered drugs the rest of the year. (3)
Premiums are the wild card. In 2026, the Part D Premium Stabilization Demonstration cut the base premium by $10 and limited increases to $50 a month. (4) CMS is ending it after 2026. (6)
CMS Administrator Mehmet Oz has said most beneficiaries should see premiums rise by less than $10 a month. (7) KFF cautions that some stand-alone plan enrollees could face bigger jumps than in recent years. (4)
There’s real good news, too. Medicare’s negotiated prices for 15 more drugs — including Ozempic, Wegovy, Trelegy Ellipta and Xtandi — take effect Jan. 1, 2027. (8)
3. The letter in your mailbox
Your plan had to send you its Annual Notice of Change, or ANOC, by Sept. 30. (9) No letter? Call your plan.
Don’t toss it. Start with the premium and deductible, and compare next year’s numbers with this year’s.
Next, find every drug you take on the formulary, which is the plan’s list of covered drugs. A drug that’s dropped means paying full price or switching.
Then check tiers. A medication that moves from a lower tier to a higher one can cost you a lot more at the counter, even if the premium didn’t budge.
Finally, check the pharmacy network. If your drugstore is leaving the network, or losing “preferred” status, your copays can rise.
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4. Shop between Oct. 15 and Dec. 7
Medicare’s open enrollment runs Oct. 15 through Dec. 7. (9) That’s your window to switch drug plans or move between Original Medicare and Medicare Advantage.
Type your exact prescriptions, doses and pharmacy into the Medicare Plan Finder at Medicare.gov. The plan with the lowest premium often isn’t the plan with the lowest total cost for the year.
Choices are thinning out, too. Kiplinger reports the average number of stand-alone drug plans available to enrollees has fallen sharply over the past five years. (2) That’s one more reason not to renew on autopilot.
If your costs come in big chunks early in the year, the Medicare Prescription Payment Plan lets you pay them in monthly installments instead. Joining is free, but Medicare is clear it won’t lower what you owe. (10)
Money tight? Extra Help can take your premium and deductible to $0. For 2026, an individual qualifies with income up to $23,940 and resources under $18,090. For a married couple, it’s $32,460 and $36,100. (3)
In 2027, people on Extra Help pay no more than $5.80 per generic or $14.40 per brand-name drug. (3) You can apply through Social Security.
5. Shrink the drug bill itself
A better plan helps. A smaller drug bill helps more.
Ask your doctor whether a generic or a cheaper alternative would work for you, and compare mail-order prices, something Medicare itself suggests. (3) Ask, too, whether a 90-day supply costs less per dose than three 30-day fills.
Then look for discounts on the things your plan doesn’t cover well.
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6. Not on Medicare yet? Start saving for these bills now
If you’re in your 50s or early 60s, these numbers are your future. A $2,400 cap on drugs alone is money you’ll want set aside before you turn 65.
Health Savings Accounts are the only triple tax-advantaged accounts going: contributions cut your taxable income, growth is tax-free, and withdrawals for medical costs are tax-free too. Unlike an FSA, the money never expires.
Lively HSAs charge no monthly account fees, and your balance can be invested for long-term growth. On a high-deductible health plan, not yet on Medicare? Open your free HSA today.
7. Get free, unbiased help
Every state has a State Health Insurance Assistance Program, or SHIP, that offers free one-on-one Medicare counseling from people who aren’t selling anything. (11) Find yours at shiphelp.org or call 877-839-2675.
SHIP counselors know Medicare cold. For the bigger picture — how health costs fit with your withdrawals, taxes and Social Security — a financial planner can help.
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The bottom line
Credit where it’s due. Some drug prices really are falling. But the big new deal is for Medicaid, and the real good news for Medicare enrollees is the negotiated prices on 15 more drugs starting in January.
A White House fact sheet doesn’t pay your pharmacy bill. Your Medicare drug plan does. And for 2027, its deductible and out-of-pocket cap are going up, and many premiums may follow.
So give the letter in your mailbox more attention than the headlines. Check your drugs, your tiers and your pharmacy. Then run your prescriptions through Plan Finder before Dec. 7.
Politicians get to pick the numbers they announce. You get to pick your plan — but only until Dec. 7.
Sources: 1. The White House; 2. Kiplinger; 3. Medicare.gov; 4. KFF; 5. Associated Press (via PBS News); 6. CMS; 7. Forbes; 8. CMS; 9. The Motley Fool; 10. Medicare.gov; 11. SHIP National Technical Assistance Center
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