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2017 Medicare Part D Outlook
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
Below are the finalized 2017 Standard Benefit Model Plan parameters as released by The Centers for Medicare and Medicaid Services (CMS), April 2016.


Latest News on Medicare for 2017



CMS Part D 2017 Standard Benefit Model Plan Feature Highlights

Here are the highlights for the CMS defined Standard Benefit Plan changes from 2016 to 2017. The chart below shows the Standard Benefit design changes for plan years 2013, 2014, 2015, 2016 and 2017. This "Standard Benefit Plan" is the minimum allowable plan to be offered.
  • Initial Deductible:
    will be increased by $40 to $400 in 2017.
  • Initial Coverage Limit:
    will increase from $3,310 in 2016 to $3,700 in 2017.
  • Out-of-Pocket Threshold:
    will increase from $4,850 in 2016 to $4,950 in 2017.
  • Coverage Gap (donut hole):
    begins once you reach your Medicare Part D plan’s initial coverage limit ($3,700 in 2017) and ends when you spend a total of $4,950 in 2017.
    In 2017, Part D enrollees will receive a 60% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 50% discount paid by the brand-name drug manufacturer will apply to getting out of the donut hole, however the additional 10% paid by your Medicare Part D plan will not count toward your TrOOP.
    For example: if you reach the donut hole and purchase a brand-name medication with a retail cost of $100, you will pay $40 for the medication, and receive $90 credit toward meeting your 2017 total out-of-pocket spending limit.
    Enrollees will pay a maximum of 51% coinsurance on generic drugs purchased while in the coverage gap (a 49% discount). For example: If you reach the 2017 Donut Hole, and your generic medication has a retail cost of $100, you will pay $51. The $51 that you spend will count toward your TrOOP.
  • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**:
    will increase to greater of 5% or $3.30 for generic or preferred drug that is a multi-source drug and the greater of 5% or $8.25 for all other drugs in 2017.
  • Maximum Copayments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:
    will increase to $3.30 for generic or preferred drug that is a multi-source drug and $8.25 for all other drugs in 2017.





Chart Comparing 2013 through 2017 Standard Benefit Model Plan Features

Click here to see a comparison of plan parameters for all years since 2006

Medicare Part D Benefit Parameters for Defined Standard Benefit
2013 through 2017 Comparison
Part D Standard Benefit Design Parameters: 2017 2016 2015 2014 2013
Deductible - (after the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit. $400 $360 $320 $310 $325
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) $3,700 $3,310 $2,960 $2,850 $2,970
Out-of-Pocket Threshold - This is the Total Out-of-Pocket Costs including the Donut Hole. $4,950 $4,850 $4,700 $4,550 $4,750
Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap - Catastrophic Coverage starts after this point.

See note (1) below.		 $7,425.00 (1) $7,062.50 (1) $6,680.00 (1) $6,455.00 (1) $6,733.75 (1)
Total Estimated Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap Discount (NON-LIS) See note (2). $8,071.16

plus a 60% brand discount		 $7,515.22

plus a 55% brand discount		 $7,061.76

plus a 55% brand discount		 $6,690.77

plus a 52.50% brand discount		 $6,954.52

plus a 52.50% brand discount
Average NON-LIS percentage brand and generic drug purchases made during the coverage gap used to estimate the Total Covered Part D OOP threshold for NON-LIS beneficiaries (see above). Brand: 87.9%
Generic: 12.1%		 Brand: 84.6%
Generic: 15.4%		 Brand: 85.9%
Generic: 14.1%		 Brand: 86.2%
Generic: 13.2%		 Brand: 85.6%
Generic: 14.4%
Catastrophic Coverage Benefit:
   Generic/Preferred
   Multi-Source Drug (3)		 $3.30 (3) $2.95 (3) $2.65 (3) $2.55 (3) $2.65 (3)
    Other Drugs (3) $8.25 (3) $7.40 (3) $6.60 (3) $6.35 (3) $6.60 (3)
Part D Full Benefit Dual Eligible (FBDE) Parameters: 2017 2016 2015 2014 2013
   Deductible $0.00 $0.00 $0.00 $0.00 $0.00
   Copayments for
   Institutionalized
   Beneficiaries		 $0.00 $0.00 $0.00 $0.00 $0.00
Maximum Copayments for Non-Institutionalized Beneficiaries
    Up to or at 100% FPL:
        Up to Out-of-Pocket Threshold
      Generic/Preferred
      Multi-Source Drug		 $1.20 $1.20 $1.20 $1.20 $1.15
      Other $3.70 $3.60 $3.60 $3.60 $3.50
     Above Out-of-Pocket
     Threshold		 $0.00 $0.00 $0.00 $0.00 $0.00
    Over 100% FPL:
        Up to Out-of-Pocket Threshold
      Generic/Preferred
      Multi-Source Drug		 $3.30 $2.95 $2.65 $2.55 $2.65
      Other $8.25 $7.40 $6.60 $6.35 $6.60
     Above Out-of-Pocket
     Threshold		 $0.00 $0.00 $0.00 $0.00 $0.00
Part D Full Subsidy - Non Full Benefit Dual Eligible Full Subsidy Parameters: 2017 2016 2015 2014 2013
Eligible for QMB/SLMB/QI, SSI or applied and income at or below 135% FPL and resources ≤ $8,890 (individuals) or ≤ $14,090 (couples) (4)
   Deductible $0.00 $0.00 $0.00 $0.00 $0.00
    Maximum Copayments up to Out-of-Pocket Threshold
      Generic/Preferred
      Multi-Source Drug		 $3.30 $2.95 $2.65 $2.55 $2.65
      Other $8.25 $7.40 $6.60 $6.35 $6.60
   Maximum Copay
   above
   Out-of-Pocket
   Threshold		 $0.00 $0.00 $0.00 $0.00 $0.00
Partial Subsidy Parameters: 2017 2016 2015 2014 2013
Applied and income below 150% FPL and resources between $8,890-$13,820 (individuals) or $14,090-$27,600 (couples) (category code 4) (4)
   Deductible $82.00 $74.00 $66.00 $63.00 $66.00
   Coinsurance up to
   Out-of-Pocket
   Threshold		 15% 15% 15% 15% 15%
    Maximum Copayments above Out-of-Pocket Threshold
      Generic/Preferred
      Multi-Source Drug		 $3.30 $2.95 $2.65 $2.55 $2.65
      Other $8.25 $7.40 $6.60 $6.35 $6.60
(1) Total Covered Part D Spending at Out-of-Pocket Threshold for Non-Applicable Beneficiaries - Beneficiaries who ARE entitled to an income-related subsidy under section 1860D-14(a) (LIS)
(2) Total Covered Part D Spending at Out-of-Pocket Threshold for Applicable Beneficiaries - Beneficiaries who are NOT entitled to an income-related subsidy under section 1860D-14(a) (NON-LIS) and do receive the coverage gap discount. For 2017, the weighted gap coinsurance factor is 89.95%. This is based on the 2015 PDEs (87.9% Brands & 12.1% Generics)
(3) The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2017, beneficiaries will be charged $3.30 for those generic or preferred multisource drugs with a retail price under $66 and 5% for those with a retail price greater than $66. For brand-name drugs, beneficiaries would pay $8.25 for those drugs with a retail price under $165 and 5% for those with a retail price over $165.
(4) This amount includes the $1,500 per person burial allowance. The resource limit may be updated during contract year 2017.

Click here to see a comparison of plan parameters for all years since 2006







2017 Federal Poverty Level Guidelines: LIS Qualifications (2017-2018)

If your income is below 135% of the FPL (for the remainder of 2017: $16,281 if you are single or $21,924 for married couples), you could qualify for the full Low Income Subsidy (resource limits also apply - see chart above). Even if you don't qualify for full LIS benefits, you could be eligible for partial LIS benefits if your income level is at or below 150% FPL (resource limits also apply - see chart above). Remember, the LIS subsidy helps to pay both your monthly plan premiums and drug costs.

Learn more in our article, 2017 Federal Poverty Level Guidelines (FPL): 2017-2018 LIS Qualifications and Benefits.

2017 Full Low-Income Subsidy Income Requirements (135% of FPL)
Persons
in Family		48 Contiguous
States & D.C.		AlaskaHawaii
1$16,281.00$20,331.00$18,711.00
2$21,924.00$27,391.50$25,204.50
3$27,567.00$34,452.00$31,698.00
4$33,210.00$41,512.50$38,191.50
5$38,853.00$48,573.00$44,685.00
6$44,496.00$55,633.50$51,178.50


Click here for additional family member figures Learn more about the Extra-Help program.





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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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