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Q1Group 2019 PDP Analysis: Most 2019 stand-alone Medicare Part D prescription drug plans will have some initial deductible ranging from $15 to $415

Category: Annual Medicare Plan Changes
Published on 2018-09-28 12:26:36


About 71% of all 2019 stand-alone Medicare Part D prescription drug plans will have an initial deductible ranging from $15 to $415.  (Remember, you usually pay 100% of your initial deductible before your Medicare Part D plan begins to provide coverage - but, see the exceptions below when a plan may exclude low-costing formulary Tiers from the deductible.)

As background, the standard or model CMS 2019 Medicare Part D plan includes a $415 initial deductible (as compared to the standard $405 initial deductible in 2018 Medicare Part D plans) and many stand-alone 2019 Medicare Part D prescription drug plans (PDPs) will follow this CMS standard Medicare Part D plan design - although, 2019 initial deductible can range from $15 to $415.

As a state-specific example, of the 26 stand-alone 2019 Medicare Part D plans available in Ohio, 18 plans will have an initial deductible ranging from $100 to $415, and  eight (8) stand-alone Medicare Part D plans will have a $0 initial deductible.  You can see our PDP-Facts.com/2019 for Medicare Part D premium information in your state.

How many stand-alone 2019 Medicare Part D plans will have the $415 standard Initial Deductible?

Approximately 52% of all 2019 stand-alone Medicare Part D plans (468 of the 901 PDPs) will have a $415 initial deductible (or more specifically, of all the 2019 PDPs having an initial deductible (638 PDPs), 73% will have the standard deductible of $415). In comparison, approximately 48% of all 2018 stand-alone Medicare Part D plans (403 of the 782 PDPs) had a $405 standard initial deductible.**

The $0 initial deductible Medicare Part D plan losing favor over time.


In fact, according to our calculations, only 29% of all 2019 stand-alone Medicare Part D plans will offer a $0 initial deductible (as compared to 37% of the 2018 Medicare Part D plans - and looking way back, compared to 60% of 2007 PDPs that had a $0 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.

170929_Zero_Deductible.jpg


** Please note that we are not considering Medicare Part D prescription drug plans (PDPs) in U.S. Territories or Puerto Rico.

2019 Medicare Part D plans with some Formulary Tiers excluded from the Initial Deductible

As was true in 2018, a number of stand-alone 2019 Medicare Part D plans having an initial deductible should exclude some of their 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 $415 initial deductible, but your Tier 1 and Tier 2 formulary drugs are excluded from the deductible, meaning you do not need to pay the $415 before getting coverage for these lower-costing drugs.

Editorial Comment: This 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, the 2018 Humana Walmart Rx Plan has a $405 initial deductible with some of the generic formulary medications excluded from the deductible.
How does this work?  This means that, if you were still within your $405 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 (or Annual Election Period) for Medicare Advantage plans and Medicare Part D drug plans begins on October 15 and continues through December 7, 2018.

Not sure where to begin?

If you or another Medicare beneficiary needs assistance understanding how your 2018 Medicare plan is changing or to learn more about your 2019 Medicare plan coverage options, please call 1-800-MEDICARE (1-800-633-4227) and speak with a Medicare representative.






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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.
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  • 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.
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