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 2018.

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You Will Pay In 2018
 
Monthly Premium Varies by plan. Average national premium is $35.02.
 
Annual Deductible Varies by plan. Cannot be more than $405 if you do not have Extra Help. $0 if you have Full Extra Help.

$83 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 $3,750), you reach the coverage gap. During the coverage gap you will have to pay 35% for most brand name drugs and 44% 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% for your drugs at anytime during the year after you’ve met your deductible.

 
In all plans, after you have spent $5,000 out of pocket you will leave the coverage gap and reach catastrophic coverage. Catastrophic coverage is when you will pay 5% of the cost of each drug, or $3.35 for generics and $8.35 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 $5,000 is the 65% discount on brand-name drugs. The $5,000 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 56% discount for generic drugs.

 
Coinsurance/ Copayments If You Have Extra Help If you have Medicaid and your income is below 100% of the Federal Poverty Level ($12,060 a year in 2018 for individuals and $16,240 a year for couples): $1.25 for generics and $3.70 for brand-name drugs. After your total drug costs reach $7,508.75, you will get catastrophic coverage and pay $0 for each drug for the rest of the calendar year.If you have Full Extra Help: $3.35 for generics and $8.35 for brand-name drugs. After your total drug costs reach $7,508.75 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% of each prescription or your plan’s standard coinsurance (whichever is cheaper). After your total drug costs reach $7,508.75, you will get catastrophic coverage and pay $3.35 for generics and $8.35 for brand-name drugs for the rest of the calendar year.

 

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