2020 Medicare Part D

August 22, 2019



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:


Initial Deductible: 

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.



Try to do something nice for someone today, just because.




All the best,



Randall J. Lawson


The HgO Group

803-851.0219 office



National Producer Number #9276045
























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