Medicare plans that include prescription drug coverage will vary by location and which Medicare-approved private insurance company is offering the plan. These plans may also change each year, so expect changes for 2019 Medicare Part D.
Medicare plans that include prescription drug coverage are available as stand-alone Medicare Prescription Drug Plans (if you decide to remain with Original Medicare), or you may choose to enroll in a Medicare Advantage Prescription Drug plan. To qualify to enroll in Medicare Part D, beneficiaries must be enrolled in Medicare Part A and/or Part B and reside in the plan’s service area. Beneficiaries are not required to enroll in a Medicare plan that includes prescription drug coverage, but if they do not have creditable prescription drug coverage and go 63 consecutive days or more without creditable coverage, they may have to pay a late enrollment penalty when they decide to enroll in the future.
2019 Medicare Part D costs
Beneficiaries pay an additional amount out-of-pocket for Medicare Part D coverage. Each plan sets its own monthly premium and copayment or coinsurance amounts, but the Centers for Medicare & Medicaid Services determines other costs on an annual basis. Here’s some 2019 Medicare Part D cost information:
- The yearly deductible will be no higher than $415
- The initial coverage limit will be $3,820
- The out-of-pocket threshold (catastrophic coverage limit) will be $5,100
2019 Medicare Part D coverage gap
Once you’ve paid your plan’s annual deductible, if you and your plan reach the coverage limit by paying $3,820 on covered drugs, you’ll enter the 2019 Medicare Part D coverage gap (also known as the “donut hole“). Within this coverage gap, you’ll pay no more than 25% of the plan’s cost for covered brand-name prescription drugs and no more than 37% of the plan’s cost for generic prescription drugs. Please note that beneficiaries who get Extra Help paying for Part D costs will not enter the Part D coverage gap.
Each Medicare plan that includes prescription drug coverage has its own list of covered prescription drugs, known as a formulary. (A formulary may change at any time. You will be notified when necessary.) Because each plan covers a different set of prescription drugs, beneficiaries should compare plans in their area based on prescription drug coverage and costs. Additionally, while plan deductibles and coverage gap amounts are set by the government, some insurance companies may offer Part D additional assistance in the 2019 Medicare Part D coverage gap. Beneficiaries may also qualify for the low-income subsidy (LIS), also known as the Extra Help program, which is a governmental program that provides assistance with prescription drug costs. As stated above, beneficiaries in the Extra Help program will not fall into the Medicare coverage gap.