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Q1Group 2019 Medicare Part D Analysis: 613,285 people enrolled in a 2018 Medicare PDP will see an increase of 10% to 315% in their 2019 initial deductible


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Q1Group 2019 Medicare Part D Analysis: 613,285 people enrolled in a 2018 Medicare PDP will see an increase of 10% to 315% in their 2019 initial deductible
Published on 2018-10-19 17:26:42
Category: Annual Medicare Plan Changes


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 $415 deductible, you will pay the retail price for your medications until you have spent $415 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 about formulary tiers excluded from your deductible:
Many 2019 Medicare Part D plans have certain drug tiers excluded from your initial deductible.  For example, you may find that your 2019 Medicare Part D plan has a $415 initial deductible, but the deducible 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 $415 deductible.

About 8.6 million people will only see a $10 increase in their initial deductible.
The 2019 standard Medicare Part D prescription drug plan initial deductible will increase to $415 from the $405 standard deductible in 2018 and this $10 increase in deductibles will impact about 8,483,051 people currently enrolled in a 2018 stand-alone Medicare Part D plan.

However, over 500,000 people will see an increase in their 2019 initial deductible of $30 or more.
In fact, approximately 571,590 stand-alone Medicare Part D beneficiaries are enrolled in PDP that will have an initial deductible increase from $30 to $315.

The chart below highlights some of the increases in 2018 / 2019 Medicare Part D plan deductibles.

2018 Medicare Prescription Drug Plan
Deductible Increases


2019 Plan Name
Deductible

States

Members Affected

2019

2018

Incr.
% Incr.
SilverScript Choice (PDP) $415 $100 $315 315% AZ 54,782
BlueCross Rx Value (PDP) $95 $35 $60 171%
SC 15,520
Blue MedicareRx Value Plus (PDP) $350 $235 $115 49% CT, MA, RI, and VT 47,411
EnvisionRxPlus (PDP) $300 $260 or $270 $30 or $40 11% or 15% many states 233,789
EnvisionRxPlus (PDP) $365 $300 $65 22% 14 states 261,454

The good news: about 1.2 million people will see a decrease in their current initial deductible.
As in past years, some stand-alone Medicare Part D plans (PDPs) have chosen to reduce their initial deductible for the 2019 plan year. Members of the Hawaii SilverScript Choice (PDP) will  have a $0 deductible in 2019. About 1,200,000 members across various Medicare Part D plans will see a decrease of between $5 to $185.

As a note, members of the various Aetna Medicare Rx Saver and Select PDP plans will have varied changes in initial deductible ranging from a $105 decrease in WI to a $60 increase in AK and NM.

How to see the changes in your 2019 initial deductible.
Our PDP-Compare and MA-Compare tools show the highlight coverage changes for each stand-alone Medicare Part D prescription drug (PDP) and Medicare Advantage (MA or MAPD) plan across the country and include 2018 / 2019 changes in plan features such as premium, deductible, cost-sharing and formulary size changes.  Our compare tools also highlight plans that will be merged or discontinued and plans that will be added in 2019.

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 2018 Medicare Part D and Medicare Advantage plan options.


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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.