Medicare Prescription Drug Coverage
Part D Standard Benefit Design Parameters
(after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit.
|Initial Coverage Limit -
Coverage Gap (Donut Hole) begins at this point. (The Beneficiary pays 100% of their prescription costs up to the Out-of-Pocket Threshold).
|Total Covered Part D Drug Spending including the Coverage Gap -
Catastrophic Coverage starts after this point.
|Out-of-Pocket Threshold -
This is the Total Out-of-Pocket Costs including the Donut Hole.
** Catastrophic coverage is when you will pay 5% of the cost of each drug, or $3.60 for generics and $8.95 for brand-name drugs (whichever is greater).
Catastrophic Coverage Benefit
|Brand Name Drugs||$7.40**||$8.25**||$8.35**||$8.50||$8.95|
**The Catastrophic Coverage is the greatest of 5% or the values shown in the chart above.
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