The Centers for Medicare and Medicaid Services (CMS) has released the 2019 costs for a standard Part D prescription drug plans.
Here are the highlights for the CMS defined Standard Benefit Plan changes from 2018 to 2019. This “Standard Benefit Plan” is the minimum allowable plan to be offered by insurance company who has a contract with Medicare to offer Part D prescription drug insurance.
- Initial Deductible:
will be increased by $10 to $415 in 2019.
- Initial Coverage Limit (ICL):
will increase from $3,750 in 2018 to $3,820 in 2019.
- Out-of-Pocket Threshold:
will increase from $5,000 in 2018 to $5,100 in 2019.
- Coverage Gap (donut hole):
begins once you reach your Medicare Part D plan’s initial coverage limit ($3,820 in 2019) and ends when you spend a total of $5,100 in 2019.
In 2019, Part D enrollees will receive a 75% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 70% discount paid by the brand-name drug manufacturer will apply to getting out of the donut hole, however the additional 5% paid by your Medicare Part D plan will not count toward your TrOOP (True Out Of Pocket).
For example: if you reach the donut hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your 2019 total out-of-pocket spending limit.
Enrollees will pay a maximum of 37% co-pay on generic drugs purchased while in the coverage gap (a 63% discount). For example: If you reach the 2019 Donut Hole, and your generic medication has a retail cost of $100, you will pay $37. The $37 that you spend will count toward your TrOOP (True Out Of Pocket).
- Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**:
will increase to greater of 5% or $3.40 for generic or preferred drug that is a multi-source drug and the greater of 5% or $8.50 for all other drugs in 2019.
- Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:
will increase to $3.40 for generic or preferred drug that is a multi-source drug and $8.50 for all other drugs in 2019.
If you live in Maine or New Hampshire and would like to learn more about the new Medicare plans for 2019 or to go over the changes in your plan, you can call me at (207) 370-0143 or CLICK HERE to send me an email message.