If your stand-alone Medicare Part D prescription drug plan (PDP) - or Medicare Advantage plan that
includes drug coverage (MAPD) - has an initial deductible, you will usually pay 100% of your
prescription drug costs until you have met the deductible.
For example, if your Medicare plan has a $480 deductible, you will pay the full retail price for your
medications until you have spent $480 and then your plan coverage will begin (and you will only pay
a portion of the retail cost, such as a $30 co-pay or 25% co-insurance on your medications).
Reminder: Low-costing formulary tiers may be excluded from your deductible.
Many 2022 Medicare Part D plans have certain drug tiers excluded from the initial deductible.
For example, you may find that your 2022 Medicare Part D plan has a $480 initial deductible, but
the deductible only applies to medications on formulary Tier 3, Tier 4, and Tier 5 - and your
lower-costing Tier 1 and Tier 2 drugs are covered before meeting the $480 deductible.
About 9.8 million people will see a $35 increase in their standard initial deductible.
The 2022 standard initial deductible will increase to $480 from the $445 standard
deductible in 2021 and this $35 increase in deductible could impact
about 9,777,000 people currently enrolled in a 2021 stand-alone
Medicare Part D plan -- although many of the plan members receive "Extra
Help" and do not pay the deductible -- and some of these plans
exclude lower-cost generics from the deductible.
Over 3.4 million people will see
an increase in their 2022 initial deductible of $70 or more.
In fact, over 3 million stand-alone Medicare Part D beneficiaries are enrolled in PDP that
will have an initial deductible increase from $100 to $275.
|
Medicare Prescription Drug Plan |
||||||
|
2022 Plan Name |
Deductible |
States |
Members Affected |
|||
2022 |
2021 |
Incr. |
% Incr. | |||
| SilverScript Choice (PDP) | $480 | $205 to $445 | $35 to $275 | 7.5% to 134% | in all states | 3,455,120 |
| Horizon Medicare Blue Rx Saver (PDP) | $400 | $150 | $250 | 167% | in NJ | 9,910 |
| Humana Premier Rx Plan (PDP) | $480 | $305 | $175 | 57% | in PR | 3,431 |
| Wellcare Value Script (PDP) | $480 | $350 | $130 | 37% | in SC | 13,472 |
| Blue MedicareRx Value (PDP) | $400 | $290 | $110 | 38% | in MO | 4,342 |
| Regence Medicare Script Basic (PDP) | $410 | $300 | $110 | 37% | in ID UT | 1,886 |
| Asuris Medicare Script Basic (PDP) | $410 | $300 | $110 | 37% | in OR WA | 2,900 |
| BlueCross Rx Value (PDP) | $400 | $300 | $100 | 33% | in SC | 11,854 |
The Good News: About 700,000 people
will see a decrease in their initial deductible.
As in past years, some stand-alone Medicare Part D plans (PDPs)
have chosen to reduce their initial deductible for the new plan year.
The 687,000 members of the AARP MedicareRx Walgreens (PDP) will have a
$310 deductible in 2022 down from $445 in 2021.
How to see the changes in your 2022 initial deductible.
Our PDP-Compare
and MA-Compare
tools highlight coverage changes for each stand-alone Medicare Part D prescription drug
(PDP) and Medicare Advantage (MA or MAPD) plan and include 2021 / 2022 changes
in
plan features such as premium, deductible, cost-sharing and formulary
size changes. Our compare tools also show plans that will be merged or
discontinued and plans that will be added in 2022.
Not sure whether you want an initial deductible?
Medicare beneficiaries can telephone Medicare at 1-800-633-4227, speak with a Medicare
representative, and learn more about Medicare plan coverage and their 2022 Medicare Part D and
Medicare Advantage plan options.