Part D Phases for 2018

1. The Deductible

Medicare has set the 2018 prescription drug deductible at $405. This is the amount that you will pay; through your Part D plan, before drug coverage begins. Some plans do not charge a deductible; or only charge the deductible on brand name prescriptions. However, all plans are responsible for paying the $405 deductible to Medicare on your behalf.

2. The Initial Coverage Limit

This is the phase that is governed by set copayment amounts based on the Formulary Tiers that your prescriptions are in. This phase goes until the TOTAL drug costs paid by both the plan and the member reach $3750.

3. The Coverage Gap (Donut Hole)

After a member’s total drug costs have reached $3750, the member will be responsible for 44% of generic drug costs and 35% of the brand name drug costs until the member’s total out of pocket has reached $5000. The actual drug costs during this phase will be determined by the pricing contract that your Part D plan and the pharmacy have.

4. Catastrophic Coverage

After the member’s yearly out-of-pocket costs reach $5000, copayments go to $3.35 for generic drugs and $8.35 for brand name drugs; or 5% of the cost of the prescription, whichever is greater.