Changes to medical benefits
Learn about updates for 2018 Medicare Part D plans
A quick rundown of changes to the Medicare Part D Standard Benefit show slight increases in the deductible, coverage limit and out-of-pocket threshold if you meet certain income and resource limits:
As we head into 2018, it’s important to understand some of the changes in your Medicare Part D pharmacy benefits.
- Initial deductible will increase by $5 to $405. The initial deductible is the amount paid out of pocket before Medicare Part D coverage begins.
- The initial coverage limit will increase by $50 to $3,750. Medicare beneficiaries will enter the 2018 coverage gap (donut hole) when the total negotiated cost of prescription drug purchases paid by both the member and plan reaches $3,750.
- While in the coverage gap, the member is responsible for paying out of pocket for all prescription drugs but discounts will be available, and the amount the member spends on prescriptions drugs while in the donut hole will count toward the member’s True Out-of-Pocket (TrOOP) threshold.
- In 2018, the TrOOP threshold will increase by $50 to $5,000. Once the member reaches $5,000 the coverage gap ends.
- The donut hole discount for some generic drugs will increase to 56 percent. For example, if your plan’s cost for your generic medication is $100, you will pay $44 and that $44 will count toward your 2018 TrOOP.
- The donut hole discount for some brand name drugs will increase to 65 percent and members will receive credit for 85 percent of the retail drug cost toward meeting the 2018 out-of-pocket maximum or donut hole exit point. For example, if your plan’s cost for a name-brand drug is $100, you will pay $35. Your $35 out-of- pocket counts toward your TrOOP.
Open enrollment dates for 2018 are between October 15 and December 7
Visit your neighborhood Sam’s Club Pharmacy today to learn more and let us be a partner in your health.
Find a plan that works for you at www.medicare.gov/find-a-plan/questions/home.aspx