Medicare Part D – Medicare Updates: No More Donut Hole

One very exciting announcement for Medicare is the Donut Hole (Coverage Gap) will be discontinued in 2020! The Donut Hole has been a looming terror for anyone that takes tier 3 or tier 4 medications and many people are not sad to see it go. In this level of coverage, you would have to pay around 45% of your brand name drug costs and around 80% of your generic costs but not anymore. These are the different levels of the new Part D drug plans for 2020:

  1. The Deductible Level
  • The new deductible for 2020 is $435. For those of you that have a tier deductible and take a tier 1 (preferred generic) or tier 2 (non-preferred generic), this deductible does not apply. These medications will most likely range from $1.00 to $4.00.
  1. The Initial Coverage Level
  • I call this the Co-Pay Level. Once you meet your deductible, you would pay 25% of the company’s negotiated price for the medication.

3.The Catastrophic Coverage Level

  • Once you and the insurance company reach $6,350 in drug costs, this would bring you to the third level of the drug plan called the Catastrophic Level. The government steps in and pays 95% and you would only be responsible for 5% of your cost for medications.

This next text is taken directly from Medicare.gov: https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/costs-in-the-coverage-gap/more-drug-savings-coming-through-2020#targetText=The%20percentage%20you%20save%20in,generic%20drugs%20during%20the%20gap.

The percentage you save in the coverage gap (Medicare prescription drug coverage) will increase each year through 2020. In addition, you’ll continue to get the 75% discount on covered brand-name prescription drugs.

By 2020, you’ll pay no more than 25% for covered brand-name and generic drugs during the gap.
This is the same percentage you pay:
From the time you meet the deductible (if your plan has one)
Until you reach the out-of-pocket spending limit (up to $5,100 in 2019)

The actual Medicare Part D drug plans have not yet been released for 2020, but as soon as we get those, we will be happy to share those and provide any assistance with those plans. Each Medicare Part D drug plan has a different formulary and cover medications differently based on that formulary so it is important to look at the entire plan and not just the premiums. We are happy to help navigate those plans with you.

If you have any questions regarding Medicare, it’s coverage or Part D plans, please give our office a call at 1-855-368-4717 or visit one of our pages:

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