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Medicare Part D

Medicare Part D (drug coverage) can be purchased by private insurance companies.  There are two main ways to get this coverage:

  1.  Separate, stand-alone prescription plan.  This is typically done when you have a Medicare Supplement plan.
  2.  Medicare Advantage - Most Medicare Advantage plans offer the Medicare Part D prescription coverage.  

Medicare Part D Standard Benefit Plan

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.