 Medicare Part D is the newest part of Medicare, added in 2006. It provides prescription drug coverage and is voluntary. People with Medicare Advantage typically get their drug coverage through their plan. However, if you’re not in a Medicare Advantage plan, you can sign up for a prescription drug plan and pay a monthly premium, which varies based on the plan. Many also have deductibles and copayments.
Most Medicare Part D drug plans have a coverage gap, called the “donut hole.” Once you and Medicare together spend a certain amount on drugs ($3,750 in 2018), you are “in the hole” and pay 35 percent of the plan’s cost for covered brand-name drugs and 44 percent of the plan’s cost for generic drugs. Once you spend $5,000 out of pocket, you climb out of the gap, and Medicare covers most of your costs for the rest of the year. The good news? This “donut hole” is scheduled to close next year. Starting in 2019, enrollees will only pay 25 percent of the cost of all their prescription drugs when they’re in the coverage gap—the same percentage you pay from the time you meet the deductible (if your plan has one) until you reach the $5,000 spending limit. |
