HeyMOE Tip

• In your results, look for any drug labeled “Not covered.” That’s your budget gremlin.
• Click the drug to see plan notes. Then ask your prescriber about therapeutic alternatives that are on-formulary (often the fastest path to savings).
• Tiny premium ≠ lowest total. Always compare Total Cost, not just the monthly premium—HeyMOE already does this math for you.
• If you change a med or dosage, re-run your results. One tweak can flip a plan from “ouch” to “ahh.”

Why does my total out-of-pocket cost show more than $2,100?

We get this question a lot—and honestly, we get it. The way Medicare Part D spending limits work can be confusing. Here’s the simple version.

The $2,100 limit applies only to drug refill costs

The Part D out-of-pocket spending limit (sometimes called the “catastrophic cap”) applies only to what you pay at the pharmacy counter for covered drugs—your copays/coinsurance.

But your HeyMOE Total Cost includes:

1. Drug copays (subject to the $2,100 limit), plus

2. Monthly plan premiums (not capped)

EXAMPLE:
Plan premium = $12.60/month
Your drug copays hit the spending limit ($2,100 in 2026).

Math: $2,100 (copays) + $151.20 (premiums) = $2,251.20 total out-of-pocket 

Uncovered drugs aren’t capped

If your plan doesn’t cover a medication, you pay the full retail price, and those dollars do not count toward the $2,100 limit.

Example:
6 covered drugs + 1 uncovered drug at $100/month + plan premium $12.60/month.

Math: $2,100 (covered drug copays) + $151.20 (premiums) + $1,200 (uncovered). = $3,451.20 total out-of-pocket