What is Medicare Part D Catastrophic Coverage?

Medicare Part D Catastrophic Coverage is the fourth stage of Medicare Part D drug coverage, following the Coverage Gap or ‘Donut Hole’ stage. Unless you receive Extra Help from Medicare (and therefore do not have a Coverage Gap), you automatically leave the Coverage Gap and enter the Catastrophic Coverage stage once you've spent a total of $5,000 (in 2018) and $5,100 (in 2019) in True Out-of-Pocket Part D drug costs.

In the Catastrophic Coverage stage, you pay only a coinsurance or copay for covered drugs for the remainder of the plan year. On January 1st, your plan restarts again, and begins either at the Part D Annual Deductible stage, or in the Initial Coverage stage if your plan doesn’t have a deductible.


Return to the Medicare FAQ section to view more answers to other commonly asked questions about Medicare prescription drug coverage.