Here’s What You Need to Know About the 2019 Changes to Medicare Part D Coverage

Here’s What You Need to Know About the 2019 Changes to Medicare Part D Coverage

Medicare plans and health insurance coverage can be confusing. Here’s a breakdown of what Medicare Part D is and what changes are in store for 2019.

What Does Medicare Part D Cover?

Medicare Part D is Medicare’s prescription drug coverage. It has its own list of drugs that are covered, which is called a formulary. Drugs are then placed in different tiers, which have different costs and coverages.

Medicare Part D Deductible Changes for 2019

In January 2019, the Medicare Part D deductible will vary. In some plans the deductible will go from $10 to $415. This means that you must pay $415 before Medicare begins to pay its share of the prescription cost.

Medicare Part D Initial Coverage Limit Changes for 2019

The Medicare Part D initial coverage will go from $3,750 to $3,820 beginning on January 1, 2019.  Once you and your prescription plan have hit $3,820 in 2019 for covered drugs, you’ve reached the Medicare “donut hole.” In the donut hole coverage gap, your prescription coverage is temporarily limited until you reach your out-of-pocket threshold.

Medicare “Donut Hole” Changes for 2019

With the Affordable Care Act and the Bipartisan Budget Act of 2018, Medicare is trying to close the “donut hole” coverage gap. Beginning in 2019, Medicare Part D enrollees will now receive a 75% discount on the total cost of their brand name drugs purchased between their Initial Coverage and their Out-of-Pocket Threshold.

Medicare Part D Out-of-Pocket Threshold Changes for 2019

In 2019, the out-of-pocket threshold will increase from $5,000 to $5,100. This is the amount of money you must pay to exit the Medicare “donut hole.” In other words, once you’ve payed $5,100 for prescriptions through your plan, you begin your catastrophic coverage benefit.

Medicare Part D Catastrophic Coverage Benefit Changes for 2019

In 2019, the minimum cost-sharing once you’ve met your out-of-pocket threshold of ($5,100) will increase to either 5% or $3.40 for generic or preferred multi-source druga, or to either 5% or $8.50 for all other drugs.

How Can Simplefill Help Those Who Can’t Afford Their Prescriptions?

Simplefill prescription assistance can often help people in the “donut hole” coverage gap, people who are uninsured, people whose copay is unaffordable, or people whose medication isn’t covered. If you’re having trouble affording your prescriptions for any reason at all, start an application online or call us at 1.877.386.0206 and a Simplefill Advocate will respond within 24 hours.

 

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