2018 Medicare Part D Prescription Drug Plans Coverage Changes

With new changes in Medicare Part D prescription drug coverage from 2017 to the new 2018 plans, many benefiting from Medicare are wondering how their plan will change.

Medicare Part D, which is responsible for covering prescription drugs, is showing changes from the initial deductible to the out of pocket threshold, continuing the trend of increases from 2014-2018.

In the sections below, we’ll discuss the changes that will take effect regarding Medicare drug plans for 2018.

2018 Changes for Medicare Part D Prescription Drug Plans

2018 Changes for Medicare Part D Prescription Drug Plans

Standard Medicare Part D Initial Deductible for 2018

The initial deductible for Medicare Part D recipients will increase by $5, going from $400 in 2017 to $405 in 2018. While this represents the smallest yearly increase in the last four years, it comes on the heels of a $40 boost in initial deductible from 2016-2017. Overall, it’s a minor increase that should have little impact on policyholders.

Initial Coverage Limit for 2018 Medicare Prescription Drug Plans

For 2018, the initial coverage limit increases by $50, going from $3,700 to $3,750. For those unfamiliar with Medicare Part D coverage details, the initial coverage limit covers the cost of your drug purchases until you reach the limit. Once you reach the initial coverage limit, you enter the coverage gap, commonly known as the “Donut Hole;” more about the gap will be explained shortly.

Total Out of Pocket Threshold (TrOOP) for Medicare PDPs in 2018

The out of pocket threshold, also known as TrOOP, increases $50 in 2018, from $4,950 to $5,000. TrOOP stands for ‘true out of pocket costs.’ When the out of pocket threshold is met, then you leave the “donut hole” and enter what is known as the “catastrophic coverage phase” where you again receive coverage for prescription drugs.
However, if the out of pocket threshold seems high, it’s important to note that under the Medicare Part D plan, both initial deductible payments and cost-sharing costs go towards the TrOOP along with any payments made during the coverage gap–essentially, anything paid out of pocket counts towards reaching the out of pocket threshold limit.

What is the Coverage Gap and How Has It Changed in 2018?

The coverage gap phase, commonly known as the “Medicare Part D donut hole“, is a phase in which you must pay for medications out of pocket. It starts when you reach the initial coverage limit, which is $3,750 for 2018, and is finished once you’ve reached the out of pocket threshold, $5,000 in 2018.

However, starting in 2018, Medicare Part D policy holders will now receive a 65% discount on the total cost of brand-name drugs purchased while in the coverage gap.

This “Donut Hole Discount” consists of a 50% discount from the drug manufacturer as well as an additional 15% from Medicare. The manufacturer discount will still count towards getting you out of the coverage gap, but the additional 15% paid by Medicare will not count towards your TrOOP.

How has Minimum Cost-Sharing Changed?

Minimum cost-sharing, which applies during the “catastrophic coverage portion”, will increase in 2018 to 5% or $3.35 (whichever is higher) for generic or preferred drugs, and 5% or $8.35, once again depending on which is greater, for all other drugs.

How has the Maximum Copay Changed?

The maximum copay applies when below the out of pocket threshold, i.e. when you’re in the coverage gap, but is available only for low-income, full subsidy eligible policyholders. For 2018, the maximum copay increase to $3.35 for generic or preferred brand drugs and $8.35 for other drugs.

When will the new 2018 Medicare Part D plans be available to review?

CMS usually publishes the new plan information sometime between the end of September and beginning of October.

Compare 2018 Medicare Prescription Drug Plans Rates Online

Because Medicare Part D plans are available through private insurance companies, as long as they’re approved by Medicare, monthly rates can vary depending on the plan.

It can be difficult to consider all factors affecting which plan is right for you, so for assistance, call or click the number listed above to get expert advice from our team, or you can compare 2018 Medicare prescription drug plans rates online here!

Was this article helpful?

Related Articles

Leave Comment

Your email address will not be published. Required fields are marked *

clear formSubmit