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Medicare Part D | Deductible | Copay | Coverage Gap

Doctor Reviewing Medicine with Senior ManSome features of Part D plans are the same for all plans

Comparing Part D plans can be a pain! Aside from the formulary and monthly premium, you need to compare the deductibles, copays and whether a plan includes coverage in the gap.

There are some things you don’t have to worry about. The Part D Standard Benefit Model sets many of the parameters that apply to all plans.

This model can change each year, but you will be notified from your current plan when they mail the Annual Notice of Change.

Standard Medicare Part D benefit parameters

Each year CMS sets parameters for Part D plans. Providers of Part D can offer unique features and benefits, as well as set competitive premiums, but they cannot alter the following parameters.

 2013 Plans

  • Plans can include a deductible of $325.
  • Initial coverage limit is $2970.
  • Maximum out-of-pocket (MOOP) threshold is $4750.
  • Minimum co-pays (catastrophic Portion of benefit) is $2.65 for generic/preferred and $6.60 for all other drugs.

Since Part D is a federally regulated program all Part D Medicare plans have the same limits.

Medicare Part D Donut Hole for 2013

Part D plan members will receive a 52.5% discount on their name brand drugs in the coverage gap. If you have ever reached the coverage gap you know that saving 50% on your name brand drugs can be a significant savings. You will only pay 79% of the cost for generic drugs while in the donut hole.

Comparing Medicare Part D plans – what to consider

Most Counties will have at least a couple dozen Part D plans to choose from. You will see recognizable plans such as AARP Medicare Part D plans and Humana Medicare Part D plans as well as a host of plans that you may never heard of.

You can make an informed decision is you keep these factors in mind:

  • Medicare Part D plans are annual plans and unless you are dis-enrolling from a Medicare Advantage you will have the plan through the end of the year.
  • Make sure your drugs are included in the plan’s formulary.
  • Determine which tier a drug is in and compare that to other plans. Sometimes one plan will have a drug in tier 2 while another company will place the same drug in tier 3.
  • Don’t get fooled by a low premium,only to have a $325 deductible. Do the math to look at the whole picture.



Too many people choose a plan based on the premium and the co-pays rather than looking at the entire picture. Also make sure your pharmacy will readily accept the plan as sometimes small pharmacies do not accept all plans.

The easiest way to compare Medicare Part D plans is online. Once you find a Part D plan you can generally submit the application online and avoid meeting with an agent.

No comments

  1. From what I read above it is not clear if you will still be able to change plans each year from Nov 15 – Dec 31. I had a situation where an expensive drug was changed from tier 2 to tier 3 with my original plan. I was able to switch to another plan in 2010 – is this option now gone? Are you stuck with the plan you choose for 2011 FOREVER???

  2. Jan, The Annual Enrollment Period for Medicare Part D is not changing for 2011. You can enroll in a 2011 plan or change plans November 15 2010 through December 31 2010. The Open Enrollment Period that existed January 1 through March 31 has been eliminated. I’m sorry for any confusion the article may have caused.
    David

  3. Interested in United Healthcare Plan but can’t find cost of available plans on this website or any other website. Can you help?

  4. Thanks for clarifying…wish there were some plan for those who never use drugs.

  5. You’re welcome.

  6. i am under no medication. i have not taken a rx med in 5 years, but i need something (rx plan) for emergency meds. is my best option the low monthly premium and $310 deductible ?

  7. Marvin, If I had similar circumstances, I would investigate the Humana Walmart-Preferred RX plan. You will have a $310 deductible, but the premium is only $14.80 per month.

  8. Can you tell me what Humana’s policy is re. member leaving state for a few months. My pharmacy is willing to mail Rx’s to me, but advised I contact Humana.

  9. Billie, My understanding is that for stays of a few months you shouldn’t have an issue. I’ve searched Humana’s website but did not find a specific information related to your question. Just to be on the safe side I would call Humana customer service and hear it from the horses mouth.

  10. My parents have AARP medicare complete with Secure Horizons I found out that if they should develop cancer and require Intravenous chemotherapy they would have to pay 20% out of pocket. Do you know if they can upgrade with AArp?

  11. Chinojosa, AARP Medicare Complete Plans vary County-by-County across the US. I’m not aware of all options without knowing their location. Typically there is not an option to upgrade a Medicare Advantage plan but you could change plans. Also, if intravenous chemotherapy is a concern, you may want to explore a Medicare supplement with a stand-alone Part D Plan if it is affordable. Here’s an article comparing AARP Medicare Plans. To get additional information about AARP Medicare Complete plan options in your area for 2011 visit http://www.aarpmedicareplans.com.

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