What you need to know about Medicare Part D

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Thursday, November 14, 2019

Medicare Part D open enrollment may feel like open season to you. There is so much information coming at you might feel caught in the crossfire. Let me provide some basic information.

Part D has five phases:

* Phase 1 — Premium: You will pay your premium each month to your insurance plan. This phase is constant the entire year.

* Phase 2 — Deductible: At the start of the year, you pay a deductible at the pharmacy before your plan will help with drug costs. The max deductible in 2020 is $435.

* Phase 3 — Coinsurance: Once you meet the deductible, you and your plan pay set copays or a percentage of the drug cost. In this phase you pay a reduced portion of your drug cost and your plan pays a portion. In 2020, after you and your plan have spent $4,020 combined you will enter the “donut hole” or coverage gap phase.

* Phase 4 — Gap Coverage (“Donut Hole”): In this phase you pay 25% of your generic and brand name drug cost. After you, your plan, and the manufacturer (if the drug is a brand name) have spent a combined $6,350 in 2020 you enter the catastrophic phase.

*Phase 5 — Catastrophic Coverage: In this final phase, you pay $3.60 for generics under $72 or 5% if they cost more, and $8.95 for brand name drugs under $179 or 5% if they cost more. This structure remains until the end of the calendar year.

We recommend an annual Medicare review during open enrollment as plans change yearly. The plan you are in now may not be the most cost-effective plan for you in 2020. Also, plans vary from person to person, and out of pocket costs and copays for some individuals may differ than what is listed above. Consult www.Medicare.gov, your local insurance agent, a local advocacy agency, or a trusted pharmacy professional to help you enroll in the best plan for you.

Eric Daume, Pharm. D, is a pharmacist at MediCenter Pharmacy in Cape Girardeau.