Medicare Part D What s new for 2018?

Transcription

1 Medicare Part D What s new for 2018? Prepared by NSEA-Retired As a service for members Medicare Part D for

2 Medicare Part D 2018 Deductible will be $405 Premiums change (amount depends on which plan you are enrolled in) Co-pays and donut hole payments go up. Coinsurance goes until $3,750 Catastrophic coverage begins when you have paid $5,000 out of your own pocket (includes deductible and any co-pays. Medicare Part D for

3 What is the donut hole? Donut hole Initial coverage Catastrophic coverage Deductible You pay this Medicare pays this Medicare Part D for

4 Medicare Part D 2018 Sign up for Part D when you sign up for Medicare (23 plans available premiums range from $20.40 to $ per month) Change plans during open enrollment period, October 15 thru December 7, 2017 New plan year starts 1/1/2018 You can change Part D plans each year during the open enrollment period Medicare Part D for

5 Health Reform Law closes donut hole by 2020 Starting in 2011 Part D enrollees got a 50% discount on the cost of brand-name drugs during the donut hole, paid for by pharmaceutical manufacturers 65% discount applies for 2018 (50% from drug company, 15% from Part D insurance plan) Co-insurance during the donut hole will be 25% by 2020 (phased in over time) Generic drugs will cost less, too (56% discount in 2018) Medicare Part D for

6 Drug costs by 2020 Before Reform By % paid by you 15% paid by plan, 80% paid by Medicare 5% paid by you 15% paid by plan, 80% paid by Medicare Catastrophic coverage begins Coverage gap 100% paid by you (minus $250 rebate) Donut hole Coverage gap 25% paid by you Brand name: 50% manufacturer discount, 25% paid by plan Generic 75% paid by plan Coverage limit 25% paid by you 75% paid by plan 25% paid by you 75% paid by plan Deductible 100% paid by you Deductible 100% paid by you Medicare Part D for

7 Cost sharing during donut hole Brand-name drugs Generic drugs You pay Plan pays Manufacturer pays You pay Plan pays 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Medicare Part D for

8 Deductible, 75/25 copay amounts for 2018 $4,000 $3750 $3,500 $3,000 $3700 $2,500 $2,000 $1,500 $1,000 $500 $0 25/75 copay for $3,300 $2,475 Drug plan $2,509 pays this 25/75 copay for $3,345 $825 You pay this $836 $400 Deductible $ Medicare Part D for

9 You pay more in the Donut Hole. During the donut hole you get a 50% drug-company discount and 15% from plan on name-brand meds; 56% discount on generics. $8,000 $7,000 Total out-of-pocket drug cost = $7,425 Total out-of-pocket drug cost = $7, $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0 Donut hole $3,725 $3, You pay 35% on name brands in 2018 $3,700 $3,750 Deductible and copay amounts Medicare Part D for

10 Medicare Part D 2018 The catastrophic limit (where you pay 5% of drug costs, and your Medicare Part D plan pays 95%) starts after your drug costs exceed $7, This copay amount would last for the rest of the plan year Your true out-of-pocket cost is $5,000 before the catastrophic coverage starts (deductible, co-insurance, and donut hole) Medicare Part D for

11 Things to keep in mind Lowest premium cost is not necessarily the least expensive drug plan Plans differ on the deductible, the co-pay amounts, and the cost of the drugs Best way to compare plans is on the Medicare web site: Medicare Part D for

12 Penalty premium for not signing up If you don t sign up for Medicare Part D when you are first eligible, a permanent premium surcharge penalty is applied when you do sign up (if coverage break is 63 days or more) Penalty is 1% of the national average Part D base premium for each month that you delay Avg. Premium in 2018 is $33.50, so penalty is $0.335 per month of delay, rounded to 10 For 12 mo. delay, 12% penalty is $4.02, rounded to $4.00 For 24 mo. delay, 24% penalty is $8.04, rounded to $8.00 For 36 mo. delay, 36% penalty is $12.06, rounded to $12.10 Penalty lasts for life! Medicare Part D for

13 Ways to avoid the premium penalty for Part D Join a Medicare drug plan when you are first eligible Don t go 63 days or more in a row without a drug plan or other creditable coverage Creditable coverage is coverage: Through your employer as an active employee TRICARE or VA coverage, etc. Tell your drug plan about coverage you had that was creditable Medicare Part D for

14 Need more information? MEDICARE ( ) SHIP program VAS program BC/BS web site: AARP web site: Your neighbors! Medicare Part D for