2018 Benchmark for Medicare Prescription Drug Coverage
Below is the defined standard benefit model as set by Centers for Medicare and Medicaid Services (CMS) for the 2018 plan year. All plans must include these Coverage Stages and provide benefits as good as or better than those shown.
Part D Coverage Levels
What You Pay
|Deductible||100%||$0 to $405|
|Initial Coverage Period||25%||After deductible and until total prescription drug costs reach $3,750*|
|Coverage Gap (Donut Hole)||
50% paid by drug company
35% Paid by member
15% Paid by Plan
56% Paid by Plan
44% Paid by member
|Starts when total yearly drug costs reach $3,750 and until your yearly out-of-pocket drug costs reach $5,000|
$3.35 for generic,
$8.35 Brand, or 5%, whichever is greater
|Starts after your out-of-pocket drug expenses reach $5,000 and runs through the rest of the calendar year|
*Coverage Gap: In 2018, Part D enrollees will receive a 65% discount on the total cost of their brand-name drugs purchased while in the donut hole. The discount includes, 50% discount paid by the brand-name drug manufacturer and will apply to getting you out of the donut hole, however the additional 15% paid by your Medicare Part D plan will not count toward your out of pocket. Also, Medicare Part D beneficiaries will receive a 56% discount on generic drugs purchased while in the donut hole and the 44% spent by the beneficiary will county towards their total out of pocket.
By 2020 government subsidies, discounts from drug companies and plan coverage are projected to cover 75% of medications in the coverage gap thereby matching the benefit provided in the Initial Coverage Period.