There are some changes coming to Part D starting in 2020-it's hard to believe, but it's not that far away! We've broken it down a little, to make the all-consuming information seem a little less daunting.
The following are the new changes, or increases effective January 1, 2020:
Will go up $20 to $435
Initial Coverage Limit (ICL):
Increases $200 to $4020
Out-of-Pocket Threshold (TrOOP):
Increases from $5,100 in 2019 to $6,350 in 2020.
Coverage Gap (Donut Hole):
This begins once you reach your Medicare Part D plan’s initial coverage limit ($4,020 in 2020) and ends when you spend a total of $6,350 out-of-pocket.
2020 Donut Hole Discount:
Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole.
The discount includes, a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan.
The 70% paid by the drug manufacturer combined with the 25% you pay, count toward your TrOOP or Donut Hole exit point.
For example: If you reach the Donut Hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your 2020 total out-of-pocket spending limit.
Medicare Part D beneficiaries who reach the Donut Hole will also pay a maximum of 25% co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75% discount).
For example: If you reach the 2020 Donut Hole, and your generic medication has a retail cost of $100, you will pay $25. The $25 that you spend will count toward your TrOOP or Donut Hole exit point.
Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit:
Beneficiaries will be charged:
For generic or preferred multi-source
$3.60 for drugs with a retail price under $72 and 5% for those with a retail price greater than $72.
For brand-name drugs:
$8.95 for drugs with a retail price under $179 and 5% for those with a retail price over $179.
Maximum Co payments below the Out-of-Pocket Threshold for certain Low Income Full- Subsidy Eligible Enrollees:
$3.60 for generic or preferred drug that is a multi-source drug & $8.95 for all other drugs.
Again, these prices will not take effect until January 1, 2020.
As always, if you have any questions, please give us a call.
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All the best,
Randall J. Lawson
The HgO Group
National Producer Number #9276045