UNITED STATES—Toni: Last year, the 2019 Medicare and You handbook did not include the 2019 Part D deductibles and “Donut Hole” costs, and I got in the “famous” Medicare donut hole last March.
I know it is only September, but I would like to get prepared and really cannot find the answer online or at the Medicare.gov website. Please inform me what the 2020 Medicare Part D costs. I did not see the 2020 Medicare Part D costs in either in the handbook or Medicare website. I look forward to what you have to say. Carrie, League City area.
Carrie: You are correct that the 2020 Medicare and You handbook did not have the 2020 Part D deductibles or out of pocket maximums. I did not foresee it being updated until October 1.
But guess what?? For the Toni Says® Medicare newspaper column readers, we have a big surprise! I know what the Medicare Part D cost, copays and Donut Hole will be for 2020.
Below are the findings regarding the 2020 Medicare Part D costs. 2020 Medicare Part D costs and co-pays are explained below.
Part D changes for 2020 are:
- Initial Deductible:
will be increased by $20 from $415 in 2019 to $435 in 2020.
- Initial Coverage Limit:
will increase by $200 from $3,820 in 2019 to $4020 in 2020 where the 2020 “Donut Hole” begins.
- Out-of-Pocket threshold cost: or (TrOOP) will increase from $5,100 in 2019 to $6,350 in 2020.
- Coverage Gap (Donut Hole):
begins once you reach your Medicare Part D plan’s initial coverage limit ($4,020 in 2020) and ends when you spend a total of $6,350 out-of-pocket in 2020.
- Does the Donut Hole go away…in 2020 is now called the Donut Hole Discount. Donut Hole Discount: Part D enrollees will receive a 75 percent Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes, a 70 percent discount paid by the brand-name drug manufacturer and a 5 percent discount paid by your Medicare Part D plan. The 70 percent paid by the drug manufacturer combined with the 25 percent you pay, count toward your TrOOP or Donut Hole exit point.
For example: If you reach the Donut Hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your 2020 total out-of-pocket spending limit.
- Donut Hole Generic Drug Costs: one will pay a maximum of 25 percent co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75 percent discount). For example: If you reach the 2020 Donut Hole, and your generic medication has a retail cost of $100, you will pay $25. The $25 that you spend will count toward your TrOOP or Donut Hole exit point.
- Catastrophic coverage: $3.60 for generics with a retail price under $72 and 5 percent for those priced greater than $72. For brand-name drugs, pay $8.95 for those drugs with a retail price under $179 and 5 percent for those with a retail price over $179.
- Prescriptions not in formulary: If your prescriptions are not in your Part D formulary, then YOU WILL pay 100 percent of the prescription drug cost. Always verify that your prescriptions are in the Part D plan chosen.
Need help understanding your Medicare options. Attend a Confused about Medicare workshop or call the Toni Says® Medicare hotline at 832-519-8664.
Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book to the Toni Says Medicare column readers at www.tonisays.com.
Reader Alert: Effective October 1, the new Medicare.gov website was released…Webinar on understanding how to navigate the new Medicare.gov site is Wednesday, October 23 at 3:00 p.m. visit www.ToniSays.com for more information.