Medicare RX Plans Information
Basic Medicare Part D coverage works like this:
Part D Monthly Premiums:
You pay premiums all year
The allowed maximum annual deductible under Part D plans is $415
Initial Coverage Limit:
$3,820. Limit is calculated by the total amount of the actual cost of your prescriptions.
Your Prescription costs $100 yet your copay is $10. The cost of the drug, $100, is applied to your coverage limit.
Coverage Gap aka The Donut Hole(DH):
Begins once the actual cost of your drugs reaches your Plan's Initial Coverage Limit of $3,820 (the combined amount plus
Ends when you spend a total of $5,100 out of pocket, which is referred to as your True Out of Pocket Threshold (TrOOP).
2019 Coverage Gap/DH Expenses:
Copays you incur during the Coverage Gap/DH, count towards satisfying your TrOOP
Generic Prescriptions: You pay a maximum of 37% co-pay on generic drugs purchased while in the Coverage
Gap/DH. You are receiving a 63% discount on the generic drug.
Brand-name Prescriptions: You pay 25% co-pay on brand-name drugs purchased while in the Coverage Gap/DH
You are receiving a 75% discount on the total cost of the brand-name drug.
Catastrophic Coverage :
Generic Prescriptions: You pay either 5% or $3.40, whichever is greater.
All Other Prescriptions: You pay either 5% of $8.50, whichever is greater.
Donut Hole Closing Date is now 2019
As a result of the Bipartisan Budget Act of 2018, the date for closing the donut hole for brand-name drugs was moved up from
Note: Even if you are not taking any Rx’s, you should enroll in a Part D Rx plan. Failing to do so will result in accruing a 1%
per month penalty for every month you could have been in a standalone PDP and was not. This penalty is “for life”—
once you do enroll in a PDP, the penalty will be added onto the new RX plan’s monthly premium.