Medicare Prescription Plans

Medicare Part D Standard Basic Benefit 2017
Prescription drug plans offer a wide variety of deductibles and co-payments. However, all plans have to follow this basic benefit outline.
Total Drug
Expenditures

  Plan pays 95% for generic and

brand name drugs

Enrollee pays

5% co-insurance

Enrollee
Expenditure
Coverage Gap

Enrollee will pay: 51% of generic costs
40% of brand costs
Plan pays 49% for generics and 10% for brands
$4,950
$3700 Co-pays

$400 Will have up to a $400 Deductible
or Co-pays
$400
$0 $0

Catastrophic Coverage: The enrollee will have a co-payment of $3.30 for generic drugs or $8.25 for brand name drugs, or 5% coinsurance, whichever is higher.

 

Additional Part D Premium for High Income Earners

Medicare charges high income earners an additional Part D premium. The premium is collected by insurance companies and is added to the plan’s standard premium.

Tax Filing Status

Individual

Joint

Married but Separate

Part D Premium is

If Your 2015 Annual Income Was*

Plan Premium

$85,000 or less

$170,000 or less

$85,000 or less

Plan Premium

+

$13.30

$85,001 – $107,000

$170,001 – $214,000

Plan Premium

+

$34.20

$107,001 -$160,000

$214,001 – $320,000

Plan Premium

+

$55.20

$160,001 – $214,000

$320,001 – $428,000

$85,001 – $129,000

Plan Premium

+

$76.20

Above $214,000

Above $428,000

Above $129,000

* Social Security uses the income reported on your federal tax return two years ago to determine your Part B and Part D premium. If your income has decreased, you can ask for a more recent tax year to be used to determine your premium, but you must meet certain criteria.

 

 

Selecting a Part D Plan

1. Make sure all your medications are on the plan’s formulary list.

2. Each plan places the drugs on its formulary list in tiers, and then sets a co-pay for each tier. See which tier the plan places each of your drugs. In 2012, some plans rated Crestor a tier 1, some plans rated it a tier 2, and some rated it a tier 3. The price difference between tiers is significant.

3. Does the plan place limits on any of your medications? Plans will ask consumers of an expensive drug to switch to a similar prescription with a lower cost.

4. Look at the plan’s mail order program. What are the savings available through mail order when compared to a retail pharmacy?

5. Is your pharmacy on the plan’s preferred pharmacy list? If not, you could pay higher co-pays.