About 86% of all 2020 stand-alone Medicare Part D prescription drug plans (PDPs) will have an initial deductible ranging from $50 to $435 with the vast majority having a $435 initial deductible.
(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 CMS 2020 Medicare Part D plan
includes a $435 initial deductible and although a Medicare plan's initial deductible can range from $0 to $435, most s
tand-alone 2020 Medicare Part D
prescription drug plans (PDPs) will use the CMS standard Medicare Part D plan deductible ($435).
How many stand-alone 2020 Medicare Part D plans will have the $435 standard Initial Deductible?
of all 2020 stand-alone Medicare Part D plans (815 of the 948 PDPs) will have an initial deductible -- ranging from $50 to $435. And, of all the 2020 PDPs having an initial deductible, 80%
will have the standard deductible of $435
(654 of the 815 PDPs). **
As a state-specific example, of the 28
stand-alone 2020 Medicare Part D plans available
, 24 plans will have an initial deductible ranging from $100 to $435, and four (4) stand-alone Medicare Part D plans
will have a $0 initial deductible. You can see our PDP-Facts.com/2020
for Medicare Part D premium information in your state.
The $0 initial deductible Medicare Part D plan losing favor over time.
Based on our analysis of the 2020 PDP landscape data, only 14%
of all 2020 stand-alone
Medicare Part D plans will offer a $0 initial deductible (as compared to
29% of the 2019 Medicare Part D plans - and looking way back, compared
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.
** Please note that we are not considering Medicare Part D prescription drug plans (PDPs) in U.S. Territories or Puerto Rico.
2020 Medicare Part D plans with some Formulary Drug Tiers excluded from the Initial Deductible
As was true in 2019, a number of stand-alone 2020 Medicare Part D plans having 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 $435 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 $435 before these lower-costing drugs receive coverage.
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, the 2020 Humana Walmart Rx Plan
has a $435 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 $435 initial deductible
and purchase a medication such as Atorvastatin Calcium (generic Lipitor®), you would
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
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 15 and continues through December 7, 2019.
Not sure where to begin?
If you or another Medicare beneficiary needs assistance understanding how your 2019 Medicare
plan is changing or to learn more about your 2020 Medicare plan coverage options,
please call 1-800-MEDICARE (1-800-633-4227) and speak with a Medicare representative.