Medicare drug benefit (Part D) costs

Section VI.b. Part D Cost Overview
Question 2 of 6 (use "Last" or "Next" buttons to see more)

Your costs with your Medicare drug plan will change every year. Each fall, your plan will send you information tell you how costs will change for the next year. The chart below shows you general Medicare drug costs for 2014.

You Will Pay In 2014
 
Monthly Premium Varies by plan. Average national premium is $32.42 .
 
Annual Deductible Varies by plan. Cannot be more than $310 if you do not have Extra Help.

$0 if you have Full Extra Help.

$63 or your plan's standard deductible (whichever is cheaper) if you have Partial Extra Help.

 
Coinsurance/ Copayments If You Do Not Have Extra Help Varies by plan and by drug within plan.

After spending a pre-determined amount in total drug costs (usually $2,850), you reach the coverage gap. During the coverage gap you will have to pay 47.5 percent for most brand name drugs and 79 percent for generic drugs. This is because as a result of the health reform law, the coverage gap is slowly being phased out. It will be phased out by 2020 when you will typically pay no more than 25 percent for your drugs at anytime during the year after you've met your deductible.

In all plans, after you have spent $4,550 out of pocket you will leave the coverage gap and reach catastrophic coverage. Catastrophic coverage is when you will pay 5 percent of the cost of each drug, or $2.55 for generics and $6.35 for brand-name drugs (whichever is greater).

Sometimes, your out-of-pocket costs include those paid by others, including family members most charities or other persons, State Pharmaceutical Assistance Programs, AIDs Drug Assistance Programs and the Indian Health Service. Also included in the $4,550 is the 52.5 percent discount on brand-name drugs. The $4,550 does not include monthly premiums, the cost of drugs that are not on your plans list of covered drugs, drugs that you bought at pharmacies outside the plan’s network, or the 21 percent discount for generic drugs.

 
Coinsurance/ Copayments If You Have Extra Help If you have Medicaid and your income is below 100 percent of the Federal Poverty Level ($11,670 a year in 2014 for individuals and $15,730 a year for couples): $1.20 for generics and $3.60 for brand-name drugs. After your total drug costs reach $6,455.00, you will get catastrophic coverage and pay $0 for each drug for the rest of the calendar year.

If you have Full Extra Help: $2.55 for generics and $6.35 for brand-name drugs. After your total drug costs reach $6,455.00 you will get catastrophic coverage and pay $0 for each drug for the rest of the calendar year.

If you have Partial Extra Help: 15 percent of each prescription or your plan's standard coinsurance (whichever is cheaper). After your total drug costs reach $6,455.00, you will get catastrophic coverage and pay $2.55 for generics and $6.35 for brand-name drugs for the rest of the calendar year.

 

Related Questions
Can my state give me more rights and protections than federal law regarding Medigap plan enrollment?

Donate Now
 
 
Go to previous question Go to next question
 
GO TO
Why am I paying a different amount for my drugs this month?

Paying a different amounts for my drugs throughout the year with Extra Help

If you are unable to afford copayments for your prescription drug plan (with or without Extra Help)

 
LINKS
State Health Insurance Assistance Program (SHIP) Directory

 
< Last | Next >