15 February 2017

Don’t Forget…Your Medicare Part D Plan Might Have a Deductible to Meet

Every January 1st, Medicare Part D prescription drug plans reset.  This means if your plan has a deductible to reach (prior to when the plan kicks in coverage), you will possibly incur higher drug copays in the early part of the year.


The maximum Part D plan deductible in 2017 is $400.  Some plans have a $400 deductible — some have a $0 deductible — and others have a $0 deductible for generic drugs, with a $400 deductible on brand name drugs.  Regardless, it’s important to remember your copays may be higher than normal during the Deductible phase of your Part D plan.


Once you meet your plan’s deductible, you will enter the Initial Coverage phase of Part D.  During this phase, your drug copays may reduce because the plan begins to pay a portion of the drug’s actual cost.  During this phase, you should pay 25% of the next $3,300 of gross drug costs (so $825 out of your pocket).  This works more like your probably used to — Tier-based pricing (i.e. Tier 1 and Tier 2 generics, Tier 3 and Tier 4 brand name).


Another item to remember — Be sure to give your most up-to-date Part D drug ID card to your pharmacist.  Without it, your claims won’t be processed appropriately, and likely will lead to denied claims and a big headache on your side.

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