2019 Part D Drug Plan Updates

The 2019 Part D drug plans have been released and there have been a few changes made. In order to better understand these changes, you need to understand how drug plans work. Most drug plans have 4 levels of coverage: Deductible Level, Copay Level, Coverage Gap and Catastrophic Level.

The updates made to the Part D drug plans are as follows:

  1. The standard deductible is $415. Keep in mind that a lot of carriers are offering a “Tiered Deductible”, meaning that the deductible does not apply to Tier 1 and Tier 2 medications. So, one would pay a small amount for Tiers 1 and 2 from the start.
  2. The copay level, the plan pays 75% of their negotiated cost and the client pays 25% as their copay. Different plans get certain medications for lower and higher costs (formulary). This is one reason it is important to shop your Medicare Part D plan every year.
  3. Coverage Gap (Donut Hole): Once the client and the Medicare Part D Plan have paid $3.820 for the medication costs, the client enters the Donut Hole. Great news! The Bipartisan Budget Act of 2018 moved up the date for closing the Donut Hole for brand name medications to 2019. This means, that for brand name medications, even when you enter into the Donut Hole, your copay will stay 25%. This should save many people a lot of money. Clients will still pay 37% of the costs for generic medications, but this is usually still a relatively small amount because most generic medications are affordable.
  4. Once the client enters the Catastrophic level, when both the client and the Medicare Part D plan have paid $5,100, the plan will pay 95% of the cost and the client will be responsible for only the remaining 5%.