2019 Part D Changes

Here are the Part D changes for 2019 that you need to know!

If your plan has a deductible it may go up. The initial Part D deductible will increase by $10.00 to $415 for 2019.

What does this mean to you?

If your Medicare Part D Rx drug plan has a deductible, you may pay more out-of-pocket in 2019 before your insurance plan begins covering your medications. For example, if you are taking Xarelto which costs about $500 and your plan has a $47 copay then the first refill will cost $462 ($415+$47) and then will be $47 each month after that until you reach the Initial Coverage Limit and enter the “Donut Hole.”

Not all Part D Prescription Drug Plans have a deductible and many plans exclude lower-cost generic drugs from the deductible, giving you coverage for these Tier 1 or Tier 2 drugs before you need to pay your deductible.

Beginning January 1, 2019 your Initial Coverage Limit (ICL) will increase from $3,750 to $3,820.

This means that you will be able to buy slightly more medications before reaching the 2019 Donut Hole or Coverage Gap.  A good rule of thumb is that if the full retail cost of your medications is less than $320 per month, you will not enter the Donut Hole before the end of the year.

Good news! The Donut Hole discount will increase 10% in 2019!

The discount you get on brand-name drugs will increase from 65% to 75%. So, if you are using a brand-name medication such as Advair which has a retail cost of around $400, you will pay $100 for your medication or if you take Lantus which has around a $300 price tag, you will pay $75 while in the Donut Hole.

What is the end result?

In 2019 you will have to spend only about $25 more to get out of the Donut Hole than you did in 2018.  The Out of Pocket Threshold (or TrOOP) has increased from $5,000 to $5,100 which will trigger entry into the Catastrophic Coverage Phase where you will remain for the rest of the year.

While in the Catastrophic Coverage Phase you will pay either 5% of the total retail cost of the drug OR $8.50 for brand-names and $3.40 for generics, whichever is higher.

If you need a more in-depth explanation of how Part D works or want to review what plans have the lowest costs and will help you avoid the Donut Hole, give me a call. My number is 207-370-0143. I will be happy to help you.

Be sure to read your Annual Notice of Change Letter (ANOC) that should arrive in the mail each year at the beginning of October to see how your plan is increasing – this may help you determine how much you need to budget in 2019 to cover the costs of coverage. [READ MORE …]

If you would like to ask a question or schedule a meeting at your home or a nearby meeting place, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.

The best part about working with me is that it does not cost you anything to talk with me to discuss your options and review the plans that are available.  My services are free to you. I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You pay nothing for my help!

And you will not pay any more than anyone else and you are under no obligation whatsoever to change your plan if you talk with me.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

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