Cost of Medicare Part D Plan Coverage
The cost of a Medicare Part D plan is influenced by several different factors. These include:
- Deductible – An amount you are required to pay before a plan begins to share the cost of prescriptions.
- Premium – The monthly payment to Medicare, an insurance company or a health care plan for health or prescription drug coverage.
- Copayment – An amount you may be required to pay as your share of the cost for a prescription drug after you pay any deductibles. A copay is usually a set dollar amount: for example, a $10 copay.
- Coinsurance – An amount you may be required to pay as your share of the cost for prescription drugs after you pay any deductibles. Coinsurance is a percentage of the cost: (for example 20%).
- Initial Coverage Stage – This is the stage after you have met your deductible and before your total drug expenses have reached $3,820 in 2019, including amounts you’ve paid and what our plan has paid on your behalf.
- Catastrophic Coverage Stage – The stage in the Part D drug benefit where you pay a low copayment or coinsurance for your drugs after you or other qualified parties on your behalf have spent $5,100 in 2019 on covered drugs during the plan year.
- Coverage Gap (Donut Hole) – A period of time in which you pay higher cost sharing for prescription drugs until you spend enough to qualify for catastrophic coverage. The coverage gap (also called the “donut hole”) starts when you and your plan have paid a set dollar amount for prescription drugs during that year.
- Generic Drug Cost – The amount you pay for your prescription if you opt for the generic rather than the brand-name version of a drug; this is often less expensive than the cost of the brand-name version.
- Brand-Name Drug Cost – The amount you pay for your prescription if you opt for the brand rather than the generic version of a drug; this is often more expensive than the cost of the generic version.
The factors above are different for each plan. But before you compare the costs of our plans, consider your location. Plan costs and benefits vary by area, so make sure you type in your zip code to see the correct plan costs and benefits.
Some members may face additional costs or fees. For example, the Part D Late Enrollment Penalty (LEP) is an amount added to your Medicare Part D premium. You may owe a Part D late enrollment penalty if, at any time after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Part D or other creditable prescription drug coverage (as good as Medicare’s).
Financial assistance is also available for eligible members. See if you qualify for Extra Help, a Social Security Administration program that helps people with limited incomes pay for their Medicare Part D costs.