This coming year the deductible phase will be increased by $5 to $405 in 2019. That does not mean every plan has a deductible, all it means is that per Medicare guidelines is that no plan can have a deductible exceeding $405 for the year. Contact BGA about obtaining a deductible free plan.
Next is the initial coverage phase which is also known as the copay or coinsurance phase.
The limit will increase from $3,700 in 2017 to $3,750 in 2019. This is basically where the Medicare member pays a flat copay for his or her prescriptions until the total annual cost of $3,750 is reached.
Next phase once you reach the limit on your copay’s will be the coverage gap also known as the “donut hole.” The TrOOP (true out of pocket) expenses will increase from $4,950 in 2017 to $5,000 in 2019.
In 2019, Part D enrollees will get a 65% donut hole discount on the total cost of their brand-name drugs bought while in the donut hole. The discount is a 50% discount paid by the brand-name drug manufacturer and will apply to getting you out of the donut hole (or TrOOP). One thing to note is that the additional 15% paid by your Medicare Part D plan will not count toward your TrOOP.
For example: If you get to the the donut hole and purchase a brand-name medication with a standard retail price $200, you will pay $70 for the medication, and receive $130 credit toward meeting your 2019 total out-of-pocket spending limit.
Part D members can expect to pay 44% for generic costs and receive a 56% discount. For those of you who only take a few generic scripts really don’t have to worry about falling into the donut hole because the retail costs for generics are usually minimal compared to brand name retail costs.
Catastrophic Coverage is the last phase a member could reach once out of the coverage gap. This is where Medicare picks up 80% of the cost, your Part D plan covers 15% and your responsibility is only 5%.
I know this basic outline is still very confusing for most of you but that’s why BGA Insurance Group is here and you should reach out to an agent for guidance and understanding. By contacting us you could end up saving yourself hundreds of dollars for your 2019 Medicare coverage.
We are licensed in the states of New Jersey, Pennsylvania, Delaware and Florida. Seniors in any of these states should take advantage of our free Medicare enrollment consultations in order to confirm that their current plan is indeed their best option.
Joe Bachmeier is a co-founder of BGA Insurance Group
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