Medicare Prescription Drug Benefits

Medicare prescription drug benefits, or Part D, reach three stages throughout the year as the plan and the member pay for the cost of medication.  Here are the three stages:

Stage 1
Initial Coverage Stage

The plan pays its share of the cost of member drugs and the member pays their share of the cost. The member stays in this stage until their payments for the year plus the plan’s payments total $2,840.

Stage 2
Coverage Gap Stage

The member pays 93% of generic drug cost and a discounted cost for brand drugs until the yearly “out ‐of ‐pocket” drug cost reach $4,550, unless they are already getting Medicare
“Extra Help”.

Stage 3
Catastrophic Coverage Stage

Once they have paid enough for their drugs to move onto this last payment stage, the plan will pay most of the cost of their drugs for the rest of the year.

It’s recommended to run a formulary (a medication list) search before selecting a Part D plan so you’ll know what tier your drug falls into and better anticipate what your maximum out of pocket cost is likely to be throughout the year.

If you contact us, we can assist you in finding a plan that will keep your costs down.