Medicare Part D 2018 Plan Benefits – Standard
Medicare Part D 2018 plans must cover at least the standard benefit or its actuarial equivalent.
- $405 deductible
- 25% of prescription drug costs between $405 and $1,241.25 = $836.25
- Part of the costs in the “Coverage Gap” (also known as the donut hole) – After total spending on drugs by the beneficiary and the plan reaches $3,750 ($3,700 in 2017) the beneficiary pays for 44% of generic drug costs and 35% of brand name brand drug costs (undiscounted).
→ In 2010 a new law was enacted that will reduce significantly the coverage gap by 2020.
This will be done by reducing the amount beneficiaries pay while in the coverage gap by a small percentage each year until 2020 when they will be responsible for only 25% of brand and generic drug costs.
- Nominal costs under catastrophic coverage: Once the beneficiary expenditures (including drug manufacturer discounts) reach a total of $5,000 ($4,950 in 2017), the beneficiary is the coverage gap and reaches catastrophic level coverage. On any future prescriptions, the beneficiary pays either a co-pay of $3.35 for generic drugs or $8.35 for brand name drugs or a co-insurance of 5%, whichever is greater.
The Medicare Part D 2018 benefits must be at least as good as the standard coverage. Some Part D plans have enhanced coverage for an additional monthly premium. Some Part D plans will have no deductibles as well.