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Medicare Part D 2022
Here are the highlights for the CMS defined Standard Benefit Plan for 2022. The “Standard Benefit Plan” is the minimum allowable plan to be offered.
Cost Sharing may change depending on the pharmacy you choose and when you enter a new phase of the Part D benefit.
Initial Deductible: $480 The amount you pay before a plan covers your prescription drug costs.
Initial Coverage Limit: $4,430
During this stage, the plan pays its share of the cost and you pay your share. You are in this stage until your payments and the plan’s payments total $4,430 for the year.
Coverage Gap (“donut hole”)
When your drug costs and plan payment for the year reach $4,430, you enter the Coverage Gap Stage (donut hole). You will pay 25% of the cost for formulary brand-name and generic drugs. You will stay in this stage until your out-of-pocket costs for the year reach $7,050.
Catastrophic Coverage After your out-of-pocket costs for prescription drugs reach $7,050, the plan will pay most of your drug costs for the rest of the year. You will pay either 5% of the cost of the drug, or a co-pay of $3.95 for generic drugs or $9.85 for all other drugs.