How Do Prescription Drug Plans Work?
Here is important information you need to know about owning a prescription drug plan:
- Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but the max amount you can be charged is $415 in 2019. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage.
- Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copy amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, even more specialized medications, and etc. In 2019, the initial coverage cap is $3,820. After you and the insurance company together have paid this amount, then you enter the coverage gap.
- The Coverage Gap – During the coverage gap, you will still generally have significant discounts for generic medications. Typically, you will pay 25% for name brand medications and 37% for generics. Your gap spending will continue until you have paid $5100 out of your own pocket in 2019.
- Catastrophic Coverage – If you should spend past the coverage gap, your plan will begin to pay 95% of the costs of your formulary medications for the rest of the year.
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The purpose of this website is to provide general information about Medicare, Medicare Advantage, Medicare Supplement (Medigap), Medicare Part D, and other health-insurance-related topics. The information on this site is for educational purposes only and is not a substitute for reviewing official Medicare resources. If you call the phone number listed on this website, you will be connected with a licensed insurance agent who can provide information about the plans they offer.
BarBon Insurance uses publicly available government sources, including official Medicare websites and publications, to help provide general information. While we believe these sources to be reliable, we cannot guarantee the completeness or accuracy of the information provided. All content on this website is for informational purposes only and may change without notice.For official and up-to-date information about the Medicare program, please visit the Centers for Medicare & Medicaid Services (CMS) at Medicare.gov.