Although you will have to wait until October 1st to find out about the changes to your specific Medicare Part D plan, the standard benefit numbers have been already released for 2018 and are as follows:
- Maximum Part D annual deductible: $405
- 25% of prescription drug costs between $405 and $3,750 = $836.25
- Donut Hole: Once the retail cost of someone’s Medicare Part D prescriptions exceeds $3,750 they will fall into the “coverage gap” also known as the “donut hole.”
- Part of the costs in the “Coverage Gap” – After total spending on drugs by the beneficiary, by certain subsidy programs and by the plan reaches $3,750 the beneficiary pays for 44% of generic drug costs and 35% of brand name drug non-discounted costs (drug manufacturers provide a 50% discount on brand name drugs.)
- Catastrophic coverage: Once beneficiary expenditures (including drug manufacturer discounts) reach a total of $5,000, the beneficiary is through the coverage gap and reaches catastrophic coverage. On any future prescriptions, the beneficiary pays either a co-pay of $3.35 for generic drugs or $8.35 for brand name drugs or a co-insurance of 5%, whichever is greater.
Be sure to review your medications during Medicare Open Enrollment (October 15 – December 7) to make sure you are on a Medicare Part D plan that adequately covers your prescriptions.