Medicare Part D Information

Medicare logoIn order to meet most prescription drug needs, Medicare allows private insurance companies to issue Medicare-approved prescription drug plans. These drug plans do not cover all prescription drugs. Beneficiaries should choose the plan that best covers their own prescription drug needs. Here are some basic rules to remember.

Drug Costs- Most Medicare-approved drug plans require that beneficiaries pay an annual deductible before the plan pays anything (see the maximum amount in row "A" in the chart below). However, some drug plans have no annual deductible.

Beneficiaries often pay 25% of the drug costs after the deductible has been met (see row "B" in the chart below). Some drug plans charge less than 25%.

Beneficiaries often pay a higher amount of the drug costs once he or she reaches the coverage gap (donut hole - see row "C" in the chart below). Some drug plans charge less during the coverage gap (donut hole).

Beneficiaries usually pays 5% of the drug costs after their annual drug costs exceed the amount described row "D" in the chart below. Some drug plans charge less after the coverage gap.

Your Drug Costs in 2019
These are maximum amounts allowed, but some plans require less
If annual drug
cost is between...
You pay... Up to a
maximum of...
Total cost plus the monthly premium...
A. $0 to $415 100% Up to $415 Up to $415
B. $415 to $3,820 25% Up to $955 Up to $1,370
C. $3,820 to $8,920 25% on generic
& 37% on
brand name
Up to $3,730 Up to $5,100
D. Over $8,920 5% No maximum The first $5,100 plus either 5% of the drug cost or $3.40 for generic and $8.50 for brand name drugs, whichever is higher

(Updated Feb 2019)

Extra Help in 2019
Also known as Low-Income Subsidy or LIS
Financial assistance for costs associated with Medicare drug plans
  Income Assets Premium Deductible Copay
*Institutionalized (nursing home, etc.) with both Medicare & Medicaid, or
*Receive services under a Medicaid waiver, such as CCP in Illinois
n/a n/a none
unless the plan's premium is more than $27.37 per month, varies by state (source: Q1Medicare.com)
none none
Medicare & Medicaid (Full-Benefit Dual Eligible) & up to 100% FPL Up to $1,041
($1,409 for couples)
Up to $2,000
($3,000 for couples)
none
unless the plan's premium is more than $27.37 per month, varies by state (source: Q1Medicare.com)
none $1.25 for generic &
$3.80 for brand name drugs,
no copay after $5,100 OOP
*Full-Benefit Dual Eligible & more than 100% FPL, or
*Medicare Savings Program (MSP) participant, or
*Medicare & SSI, but not Medicaid, recipient, or
*Less than 135% FPL
Between $1,041+ - $1,405
($1,409+ -$1,902 for couples)
Up to $7,730
($11,600 for couples)
none
unless the plan's premium is more than $27.37 per month, varies by state (source: Q1Medicare.com)
none $3.40 for generic &
$8.50 for brand name drugs,
no copay after $5,100 OOP
Medicare only & less than 150% FPL Between $1,405+ - $1,562
($1,902+ -$2,114 for couples)
Up to $12,890
($25,720 for couples)
Sliding scale based on percent of FPL
135-140% = 75% subsidy
141-145% = 50% subsidy
146-149% = 25% subsidy
$85
or plan's
deductible
if less
15% of drug costs,
after $5,100 of OOP cost is either
5% or $3.40 for generic &
$8.50 for brand name drugs
  1. Source: DHHS Centers for Medicare & Medicaid Services.
  2. FPL means Federal Poverty Level.
  3. Income amounts above do not include $20 disregard allowed in Illinois.
  4. Assets do not include up to $1,500 for burial expenses ($3,000 for couples) whether or not they have been set aside for this purpose, nor burial plot, home, car, household items, or term-life insurance.
  5. OOP means out-of-pocket drug costs
  6. Sources: Illinois SHIP & Medicare Rights Center

(Updated Feb 2019)

Premium Costs for Higher Income Beneficiaries- The amounts below are the monthly Drug Plan's Premium (DPP) amount plus an additional amount for people with higher incomes.

Your Medicare Drug Plan Monthly Premium in 2019
You Pay... If Your Annual Income is...
Individual Couple
Drug Plan's Premium (DPP) $85,000 or less $170,000 or less
DPP + $12.40 $85,001 to $107,000 $170,001 to $214,000
DPP + $31.90 $107,001 to $133,500 $214,001 to $267,000
DPP + $51.40 $133,501 to $160,000 $267,001 to $320,000
DPP + $70.90 $160,000 to $500,00 $320,000 to $750,000
DPP + $77.40 Above $500,000 Above $750,000

(Updated Jan 2018)

Sources: Medicare Costs at a Glance & Social Security POMS

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