Out-of-Pocket Cap Savings for Medicare Part D Enrollees

Out-of-Pocket Cap Savings by State

In 2024, some people with Part D prescription drug coverage who had high drug costs had their out-of-pocket drug costs capped at about $3,500. As of January 1, 2025, the cap was lowered to $2,000 annually. This out-of-pocket cap is saving millions of people with prescription drug coverage from the burden of skyrocketing medication expenses, allowing them to focus on their health instead of their bank accounts. See how many people with Medicare in your state hit the cap in the first half of 2024 and paid no more in out-of-pocket costs for the rest of year. Read the full report for more information.

Source: CMS OEDA analysis of the Medicare Prescription Drug Event (PDE) and Medicare enrollment data files.
* The IRA sets the cap at $2,000 for 2025.
** Data suppressed as per CMS disclosure rules (https://resdac.org/articles/cms-cell-size-suppression-policy).
^a Total includes suppressed territory estimates and enrollees residing outside the United States.