Frequently Asked Questions about Catastrophic Coverage

Medicare Part D Catastrophic Coverage is the fourth and final part of your Medicare Part D prescription drug plan coverage and is designed to help reduce the out-of-pocket spending for people with hig . . .

Yes.  You can estimate if - or when - you will enter Catastrophic Coverage based on your average monthly retail drug cost (only the retail price for your formulary drugs). For example, if you . . .

No, but you can choose a plan with lower retail drug prices.  Catastrophic Coverage cost-sharing is the same for all Medicare Part D plans - but, Medicare plans will have different retail drug . . .

Most likely, yes.   Usually Catastrophic Coverage drug costs increase year-to-year. In the Catastrophic Coverage phase, you will pay the greater of either 5% of the formulary drug's nego . . .

What you pay in Catastrophic Coverage depends in your level of Extra Help.  If you are qualified for Medicare Part D Extra Help or the Low-Income Subsidy (LIS), you may have either full or partia . . .

The federal government (i.e. tax payers) pays 80% of the retail drug cost, the Medicare Part D plan pays 15%, and the Medicare plan Member pays around 5% of the formulary drug's retail cost.

You enter the Medicare Part D Donut Hole when the retail cost of your formulary drug purchases exceeds your plan's Initial Coverage Limit (ICL) and you exit the Coverage Gap or Donut Hole when your ou . . .

After meeting your Medicare Part D prescription drug plan's out of pocket spending limit (TrOOP), you will exit your Medicare plan's Coverage Gap or Donut Hole and enter the last phase of Medicare Par . . .