Medicare Part D prescription drug policies consist of different levels. Here’s a breakdown of Part D plan phases:
Stage 1 – Deductible (not present in all Part D policies)
Stage 2 – Initial Coverage Period
Stage 3 – Coverage Gap, often referred to as the Donut Hole
Stage 4 – Catastrophic Coverage
After your out-of-pocket expenses reach $7,050 in 2022, you exit the donut hole and enter stage 4, also known as catastrophic coverage. When you enter the catastrophic coverage phase of your Part D prescription plan, you will be responsible for minor copayments or coinsurance for sanctioned drugs for the rest of the year. You will contribute either a 5% coinsurance or copayments of $3.95 for generics and $9.85 for brand-name medications, whichever is lesser during the catastrophic phase. Keep in mind that a 5% coinsurance may still lead to considerable out-of-pocket expenses if your prescriptions are highly priced.
For those facing challenges with the expense of their medications, numerous support programs are available. These support resources include:
- Extra Help, also recognized as the low-income subsidy, which assists individuals with lower incomes in managing prescription expenses.
- Certain states offer State Pharmaceutical Assistance Programs to aid with medication costs, Part D premiums, or other associated expenses.
- Various pharmaceutical manufacturers provide assistance programs for those with Part D policies to help with medication costs. Your physician or insurer can guide you in locating and joining these programs.
- Additionally, there are national and local charitable initiatives that offer support for medication expenses, such as:
