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Will my Catastrophic Coverage drug costs change over the years?

Most likely, yes.   Usually Catastrophic Coverage drug costs increase year-to-year.

In the Catastrophic Coverage phase, you will pay the greater of either 5% of the formulary drug's negotiated retail price - or a fixed co-pay (set annually) depending on the type of drug -- generics and preferred brand drugs that are multi-source drugs or all other drugs.  For example, in 2021, you pay the higher of either 5% of retail prices or $9.20 for brands or $3.70 for generics in Catastrophic Coverage.  And in in 2022, you pay the higher of either 5% of retail prices or $9.85 for brands or $3.95 for generics in Catastrophic Coverage.

The chart below shows the fixed cost-sharing for the Catastrophic Coverage phase over the past years.  As noted, you will pay the greater of the annual co-pay (for brands or generics) or 5% of the formulary drug's negotiated retail price - so, as retail drug prices increase, so also can your Catastrophic Coverage costs increase.

For example, if you are using a brand-name drug with a retail cost of $100, your coverage cost in the 2021 Catastrophic Coverage phase would be $9.20 (since $9.20 is greater than $5 - or 5% of $100).  But, if you were using a brand drug that now has a $400 retail cost you would pay $20 (since $20 - or 5% of $400 is greater than the standard 2021 co-pay of $9.20).

Click the plan year to see examples and more details for a specific year or click here to see a chart of Medicare Part D plan parameters for all years since 2006

Catastrophic Coverage Phase Cost-Sharing
Plan Year TrOOP Generics or
Preferred Brand Drugs
that are Multi-Source Drugs
All Other Drugs
2022 $7,050 $3.95 $9.85
2021 $6,550 $3.70 $9.20
2020 $6,350 $3.60 $8.95
2019 $5,100 $3.40 $8.50
2018 $5,000 $3.35 $8.35
2017 $4,950 $3.30 $8.25
2016 $4,850 $2.95 $7.40
2015 $4,700 $2.65 $6.60
2014 $4,550 $2.55 $6.35
2013 $4,750 $2.65 $6.60

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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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  • 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 Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
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