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2019 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 2019 defined standard Medicare Part D prescription drug plan parameters as released by the Centers for Medicare and Medicaid Services (CMS), April 2018.


Search Tools and Links

» PDP-Facts: 2019 Part D Plan Statistics
» PDP-Facts: 2019 Beyond the Numbers
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» 2019 Part D Formulary Search By Drug Letter
» 2019 Part D Drug Finder
» 2019 Quick Plan facts
» 2019 PDP-Finder: Stand-Alone Prescription Drug Plan Finder
» 2019 MA-Finder: Medicare Advantage Plan Finder
» Guided Help Searching 2019 Prescription Drug Plans
» PDP-Compare: How did each 2018 Part D Plan Change in 2019?
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» Search for 2019 Medicare Plans by Plan ID
» Search for 2019 Medicare Plans by Formulary ID
» 2019 Plan Overview by State
» 2019 Overview by CMS Region
» 2019 PDP-Planner & Donut Hole Calculator




News on Medicare for 2019



2019 defined standard Medicare Part D prescription drug plan coverage parameters

Here are a few highlights of the defined standard Medicare Part D plan changes from 2018 to 2019. The chart below shows the changes in defined standard Medicare Part D design for plan years 2015, 2016, 2017, 2018 and 2019. The CMS "Part D Benefit Parameters for Defined Standard Benefit" is the minimum allowable Medicare Part D plan coverage. However, CMS does allow Medicare Part D plans to offer a variation on the defined standard benefits (for example, a Medicare Part D plan can offer a $0 Initial Deductible).
  • Initial Deductible:
    will be increased by $10 to $415 in 2019.
  • Initial Coverage Limit (ICL):
    will increase from $3,750 in 2018 to $3,820 in 2019.
  • Out-of-Pocket Threshold (or TrOOP):
    will increase from $5,000 in 2018 to $5,100 in 2019.
  • Coverage Gap (Donut Hole):
    begins once you reach your Medicare Part D plan’s initial coverage limit ($3,820 in 2019) and ends when you spend a total of $5,100 out of pocket in 2019.
  • 2019 Donut Hole Discount:
    Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes, a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan. The 70% paid by the drug manufacturer combined with the 25% 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 2019 total out-of-pocket spending limit.

    Medicare Part D beneficiaries who reach the Donut Hole will also pay a maximum of 37% coinsurance on generic drugs purchased while in the Coverage Gap (receiving a 63% discount).
    For example: If you reach the 2019 Donut Hole, and your generic medication has a retail cost of $100, you will pay $37. The $37 that you spend will count toward your TrOOP or Donut Hole exit point.
  • Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**:
    will increase to greater of 5% or $3.40 for generic or preferred drug that is a multi-source drug and the greater of 5% or $8.50 for all other drugs in 2019.
  • Maximum Copayments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees:
    will increase to $3.40 for generic or preferred drug that is a multi-source drug and $8.50 for all other drugs in 2019.





Chart comparing 2015 through 2019 defined standard Medicare Part D prescription drug plan parameters

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

Medicare Part D Benefit Parameters for Defined Standard Benefit
2015 through 2019 Comparison
Part D Standard Benefit Design Parameters: 2019 2018 2017 2016 2015
Deductible - After the Deductible is met, Beneficiary pays 25% of covered costs up to total prescription costs meeting the Initial Coverage Limit. $415 $405 $400 $360 $320
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) $3,820 $3,750 $3,700 $3,310 $2,960
Out-of-Pocket Threshold - This is the Total Out-of-Pocket Costs including the Donut Hole. $5,100 $5,000 $4,950 $4,850 $4,700
Total Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap - Catastrophic Coverage starts after this point.

See note (1) below.		 $7,653.75 (1) $7,508.75 (1) $7,425.00 (1) $7,062.50 (1) $6,680.00 (1)
Total Estimated Covered Part D Drug Out-of-Pocket Spending including the Coverage Gap Discount (NON-LIS) See note (2). $8,139.54

plus a 75% brand discount		 $8,417.60

plus a 65% brand discount		 $8,071.16

plus a 60% brand discount		 $7,515.22

plus a 55% brand discount		 $7,061.76

plus a 55% 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: 89.31%
Generic: 10.69%		 Brand: 89.18%
Generic: 10.82%		 Brand: 87.9%
Generic: 12.1%		 Brand: 84.6%
Generic: 15.4%		 Brand: 85.9%
Generic: 14.1%
Catastrophic Coverage Benefit:
Generic/Preferred Multi-Source Drug (3) $3.40 (3) $3.35 (3) $3.30 (3) $2.95 (3) $2.65 (3)
Other Drugs (3) $8.50 (3) $8.35 (3) $8.25 (3) $7.40 (3) $6.60 (3)
Part D Full Benefit Dual Eligible (FBDE) Parameters: 2019 2018 2017 2016 2015
• 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 $1.25 $1.25 $1.20 $1.20 $1.20
- Other Drugs $3.80 $3.70 $3.70 $3.60 $3.60
• 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 $3.40 $3.35 $3.30 $2.95 $2.65
- Other Drugs $8.50 $8.35 $8.25 $7.40 $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: 2019 2018 2017 2016 2015
Eligible for QMB/SLMB/QI, SSI or applied and income at or below 135% FPL and resources ≤ $9,230 (individuals in 2019) or ≤ $14,600 (couples, 2019) (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 $3.40 $3.35 $3.30 $2.95 $2.65
- Other Drugs $8.50 $8.35 $8.25 $7.40 $6.60
• Maximum Copay above Out-of-Pocket Threshold $0.00 $0.00 $0.00 $0.00 $0.00
Partial Subsidy Parameters: 2019 2018 2017 2016 2015
Applied and income below 150% FPL and resources between $14,390 (individual, 2019) or $28,720 (couples, 2019) (category code 4) (4)
• Deductible $85.00 $83.00 $82.00 $74.00 $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 $3.40 $3.35 $3.30 $2.95 $2.65
- Other Drugs $8.50 $8.35 $8.25 $7.40 $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 2019, the weighted gap coinsurance factor is 75.3704%. This is based on the 2017 PDEs (89.81% Brands & 10.69% Generics)
(3) The Catastrophic Coverage is the greater of 5% or the values shown in the chart above. In 2019, beneficiaries will be charged $3.40 for those generic or preferred multisource drugs with a retail price under $68 and 5% for those with a retail price greater than $68. For brand-name drugs, beneficiaries would pay $8.50 for those drugs with a retail price under $170 and 5% for those with a retail price over $170.
(4) This amount includes the $1,500 per person burial allowance. The resource limit may be updated during contract year 2018.

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





Medicare Part D standard benefit trends 2006 to 2019

The graph below shows the finalized Medicare Part D defined standard benefit parameters.

2019 Final Medicare Part D defined standard benefit parameters -- annual changes since 2006

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






Federal Poverty Level Guidelines: LIS Qualifications

The LIS qualifications using the 2019 Federal Poverty Level (FPL) guidelines are shown below.  If you do not currently receive Extra Help but meet the 2019 income and asset qualifications, please apply for Extra Help at https://secure.ssa.gov/i1020/start. You could receive Extra Help for the remainder of 2019, even if your income or assets no longer meet the requirements later in the year.

 If your income is below 135% of the FPL ($16,861.50 if you are single or $22,828.50 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, 2019 Federal Poverty Level Guidelines (FPL): 2019 LIS Qualifications and Benefits.

2019 Full Low-Income Subsidy Income Requirements
(135% of FPL)
Persons
in Family		48 Contiguous
States & D.C.		AlaskaHawaii
1 $16,861.50 $21,060.00 $19,413.00
2 $22,828.50 $28,525.50 $26,271.00
3 $28,795.50 $35,991.00 $33,129.00
4 $34,762.50 $43,456.50 $39,987.00
5 $40,729.50 $50,922.00 $46,845.00
6 $46,696.50 $58,387.50 $53,703.00


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





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2025 Medicare Part D Plan Reminder Service

If you would like for us to send you an email as additional 2025 Medicare Part D plan information comes online and when enrollment begins (October 15th), please complete the form below. We will NOT share your information with any third-parties.


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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
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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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