Note: Some Medicare Part D plans exclude one or more of the generic drug tiers from the deductible. If you are enrolled in such a plan, your brand-name drug purchases would fall into the deductible but your generic drug purchases would skip the deductible and fall into the Initial Coverage phase cost-sharing.
There are a few different ways that your deductible can change for the new plan year, thus causing your medications to cost more in the early months of your new coverage...
- If your Medicare Part D plan follows the CMS standard plan model, your prescription drug plan had a $320 Initial Deductible in 2015 and now has a $360 Initial Deductible. This means that you would pay an additional $40 in 2016 before you would leave the Initial Deductible phase of coverage and move into the Initial Coverage phase. Thirty (30) Medicare prescription drug plans used the standard deductible in 2015 and continue to use the standard deductible in 2016. There are approximately 9,000,000 Medicare beneficiaries enrolled in these plans.
- Your Medicare Part D plan added an Initial Deductible. Approximately 364,000 Medicare beneficiaries are enrolled in plans that had first dollar coverage in 2015 and now have an Initial Deductible. These members will be paying more for the prescriptions in early 2016 while they are in their Initial Deductible phase of coverage. Their Initial Coverage phase cost-sharing will start after they first meet their plan's Initial Deductible. See examples in the chart below:
Plan Name Deductible Members States 2015 2016 AARP MedicareRx Preferred (PDP) $0 $360 15,273 VI, PR, GU Cigna-HealthSpring Rx Secure-Extra (PDP) $0 $250 337,294 all states Symphonix PrimeSaver Rx (PDP) $0 $200 6,141 all states United American - Enhanced (PDP) $0 $90 3,778 AL, TN United American - Enhanced (PDP) $0 $250 1,917 IL
- Your Medicare Part D plan did not use the standard deductible in 2015, but has increased its Initial Deductible for 2016. Approximately 568,000 Medicare beneficiaries are enrolled in plans that had an increase in their Initial Deductible, beyond the $40 standard increase. Members in these plans will need to pay more for their medications before entering their Initial Coverage phase. See examples in the chart below:
2016 Medicare Prescription Drug Plan
Deductible Increases2016 Plan Name Deductible States Members
2015 2016 Increase 2015 2016 Express Scripts Medicare - Choice (PDP) $50 $360 $310 all states 65,402 60,853 United American - Enhanced (PDP) Range $0-$110 Range $90-$300 Range $50-$250 many states 74,320 56,062 First United American - Enhanced (PDP) $270 $60 $210 NY 5,712 5,029 BlueMedicare Rx-Option 1 (PDP) $70 $350 $280 FL 71,930 67,253 Blue Cross MedicareRx Value (PDP) $275 $360 $85 IL NM OK TX 218,213 209,979 WPS MedicareRx Plan 1 (PDP) $170 $360 $190 WI 17,365 16,280 Regence Medicare Script Basic (PDP) $155 $310 $155 ID UT 3,678 3,507 Prescription Blue Option A (PDP) $210 $360 $150 MI 10,336 10,186 Asuris Medicare Script Basic (PDP) $195 $300 $105 OR WA 5,513 5,323 AR Blue Cross - Medi-Pak Rx Basic (PDP) $200 $300 $100 AR 27,063 27,178 Aetna Medicare Rx Saver (PDP) Range $275-$310 $360 Range $50-$85 AZ CA FL NV SC 81,028 106,314
- You switched to a 2016 Medicare Part D plan that has a higher deductible than your 2015 plan. Whether you switch from a $0 deductible plan or from a plan with a lower deductible than your new plan, you will have to pay more up front. As mentioned above, you will not enter the cost-sharing portion of your coverage until you have met your new plan's Initial Deductible.
- Your Medicare plan excludes Tier 1 generics from the deductible, however, your generic medication was moved from Tier 1 to Tier 2 non-preferred generics for 2016 and now falls into the deductible.
- In a similar scenario, your 2015 generic medication was excluded from the deductible, however you have switched to the brand-name equivalent drug in 2016 which does fall into the deductible.
In all of the examples above, you can expect to pay more for your medications during the early months of 2016 until your meet your Medicare Part D prescription drug plan's Initial Deductible and then move into the Initial Coverage phase during which you share your prescription drug costs with your plan by paying a co-pay or co-insurance.