About 83% of all 2023
stand-alone Medicare Part D prescription drug plans (PDPs)
will have an initial deductible ranging from $100 to $505
with the vast majority of these plans having a $505 initial deductible.
Remember, you usually pay 100% of your initial deductible before your
Medicare Part D plan begins to provide coverage - However, some Part D plans may exclude low-costing formulary Tiers from the deductible -- see some examples below.
As background, the
standard CMS 2023 Medicare Part D plan
includes a $505 initial deductible and although a Medicare plan's initial deductible can
range from $0 to $505, most stand-alone 2023 Medicare Part D
prescription drug plans (PDPs) will use the CMS standard Medicare Part D plan deductible ($505).
Question: How many stand-alone 2023
Medicare Part D plans will have the $505 standard Initial Deductible?
Approximately 83% of all 2023
stand-alone Medicare Part D plans (669 of the 801 PDPs) will have an
initial deductible -- ranging from $100 to $505.
And, of the 669 Medicare Part D plans having an initial deductible in 2023, most of the plans (84%) will have the
standard deductible of $505 (559 of the 669 PDPs). **
As a state-specific example, of the
24 stand-alone 2023
Medicare Part D plans available
in Ohio, 20 plans will have an initial deductible ranging from $100 to $505, and
four (4) stand-alone Medicare Part D plans
will have a $0 initial deductible. You can see our
PDP-Facts.com/2023
for Medicare Part D premium and deductible information in your state.
Question: Are the $0 initial deductible stand-alone Medicare Part D plan losing favor?
Possibly. Based on our analysis of the 2023
PDP landscape data, only 17% of all 2023
stand-alone Medicare Part D plans will offer a $0 initial
deductible as compared to 18% in 2022. Looking further back, this 17% of plans in 2023
compares poorly
to the 60% of 2007 PDPs having a $0 initial deductible**.
Here is a chart showing the changes of Medicare Part D plan designs since 2007 with fewer
Medicare Part D plans now offering a $0 initial deductible.
2023
Medicare Part D plans with some Formulary Drug Tiers excluded from the Initial Deductible
As was true in 2022, a number of stand-alone 2023
Medicare Part D plans that have an initial
deductible will exclude some of their lower-costing formulary tiers from the initial deductible
and provide immediate coverage for these drugs, even though the initial deductible is not met.
For example, your Medicare Part D plan may have a $505 initial deductible,
but your Tier 1 and Tier 2 generic formulary drugs are excluded from the deductible,
meaning you do not need to pay the $505
before these lower-costing drugs receive coverage.
Editorial Comment: Having drug tiers exempted from the deductible
is a definite bonus for people using mostly low-costing
generic medications and who usually did not meet their initial deductible until almost the
end of the plan year. Now these people will have "first dollar coverage" for their
low-costing medications, plus the usual Medicare Part D coverage protection should
they need any expensive
brand or specialty medications costing well beyond the deductible.
For example, in 2023 the
Humana Premier Rx Plan (PDP) has a $505
deductible and some formulary tiers excluded from the deductible (but, we will know more as the 2023 plan details are released).
Question: How does this work when certain drug tiers are not included in the plan's Initial Deductible?
If you are still within your $505
initial deductible
and purchase a medication such as Atorvastatin Calcium (generic Lipitor®), you would
not pay full retail price, but would instead be charged only a copayment
for this generic medication (when purchased at one of the Medicare Part D plan’s preferred
network pharmacy -- such as a Walmart pharmacy).
And
as always,
if your Medicare Part D plan’s cost-sharing is more than your drug’s retail price,
then you pay the lesser retail price (you never pay more than your negotiated retail price).
Reminder: Your Medicare plan costs and coverage can (and probably will) change
each year.
If you are interested in changing your Medicare plan enrollment, the annual Open Enrollment Period
(AEP) for Medicare Advantage plans and Medicare Part D drug plans begins
on October 15th and continues through December 7th, with your new 2023
Medicare Part D coverage starting on January 1, 2023.
Not sure where to begin?
If you or another Medicare beneficiary needs assistance understanding how your 2022
Medicare plan is changing or to learn more about your 2023 Medicare plan coverage options,
please call 1-800-MEDICARE (1-800-633-4227) and speak with a Medicare representative.