Very few Medicare Part D plans keep their cost-sharing structure (co-payments and/or co-insurance) the same from year to year. In theory, cost-sharing can increase or decrease year-to-year, but in general, the portion you pay for your prescription drugs has a tendency to rise. And each year, some prescription drug plans have increased their cost-sharing more than others.
For example, the 2017 Cigna-HealthSpring Rx Secure-Extra (PDP) plan:
- increased the co-payments for Tier 1 ($4 increase) and Tier 2 ($5 increase) generic drugs;
- changed Tier 3 preferred brands from co-insurance (20%) to co-payment ($42);
- increased the co-insurance on Tier 4 non-preferred brands to 50% in all states; and
- increased the co-insurance on Tier 5 Specialty drugs.
The following example applies to all states, except in
CT,
GA,
MA,
NV,
RI, and
VT where the Tier 4 increase is 72% (from cost-sharing of 29% to cost-sharing of 50%).
Cigna-HealthSpring Rx Secure-Extra (PDP) in Florida
2016 and 2017 Medicare Part D plan cost-sharing comparison
|
|
2016 |
2017 |
Monthly Premium |
$50.20 |
$38.70 |
Initial Deductible |
$250 |
$50 |
Gap Coverage |
No Gap Coverage |
Some Gap Coverage |
Tier |
2016
Cost-Sharing |
Tier |
2017
Cost-Sharing |
1 |
Preferred Generic |
$1 |
1 |
Preferred Generic |
$5 |
2 |
Generic |
$5 |
2 |
Generic |
$10 |
3 |
Preferred Brand |
20% |
3 |
Preferred Brand |
$42 |
4 |
Non-Preferred Brand |
43% |
4 |
Non-Preferred Brand |
50% |
5 |
Specialty Tier |
27% |
5 |
Specialty Tier |
32% |
So how does this example actually affect what people pay for their medications?
- Tier 1 preferred generic drug purchases that were $1 in 2016 will now cost members $5 at the pharmacy.
- Tier 2 generics that cost $5 in 2016 will cost $10 in 2017.
- Tier 3 preferred brand-name drugs that have a retail price less than $210 will cost more in 2017 -- using the $42 co-pay as compared to the 20% co-insurance from 2016.
For example: a $120 Tier 3 prescription will cost $42 in 2017 rather than $24 in 2016. However, Tier 3 prescriptions
with a retail price over $210 will cost less in 2017.
A $300
prescription will only cost $42 in 2017 rather than $60 using the 20% co-insurance from 2016.
- Tier 4 non-preferred brand-name drugs will increase to 50% co-insurance in all states. This is a 16% increase in most states. However, as noted above, it is a 72% increase for members in
CT,
GA,
MA,
NV,
RI, and
VT who were paying 29% for Tier 4 medications in 2016.
- Tier 5 specialty medications will cost 19% more than they did in 2016 (from co-insurance of 27% to 32% in 2017).
How to see changes in annual cost-sharing structure?
To compare annual changes in Medicare plans, our
PDP-Compare
shows changes in the 2016 stand-alone Medicare Part D prescription drug plans
(PDPs) for 2017 and our
MA-Compare
shows changes in the 2016 Medicare Advantage plans (MAs or MAPDs) for 2017. Both tools include changes in
plan features such as premium, deductible, cost-sharing and formulary
size changes. Our compare tools also highlight plans that will be merged, discontinued, or added in 2017.