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How Much is the Medicare Part D Deductible?

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Summary: The Medicare Part D deductible is an amount you might have to pay each year before your Medicare Part D benefits kick in. The Medicare Part D deductible is determined by your plan but the maximum deductible allowed in 2019 is $415.

What is the Medicare Part D deductible?

Medicare Part D is prescription drug coverage. You don’t get it automatically when you sign up for a Medicare prescription drug plan.

Medicare prescription drug plans are offered by private, Medicare-approved insurance companies that may charge premiums and deductibles for your coverage. Plans usually also charge coinsurance or copayment amounts for each covered medication.

Your Medicare Part D deductible is determined by your plan. It’s the amount you spend per year before your plan pays its share of covered prescriptions. Medicare sets a limit on the total Part D deductible amount. The maximum Medicare Part D deductible in 2019 is $415.

Some Medicare Part D plans do not have a deductible. If you do have a deductible, you will pay the full price for your medications until your deductible is met.

Understanding Medicare Part D drug tiers

Some Medicare Part D plans might only have deductibles for certain “tiers” in the plan’s formulary.

  • A formulary is the plan’s list of drugs it covers.
  • Tiers are price categories of medications in the formulary. Typically, the lowest-priced tier includes generic drugs, while higher tiers include brand-name drugs. Higher tiers could also be set for specialty medications that might cost more than most brand name drugs.

The tiers can affect your Medicare Part D deductible. Some plans only require you to pay towards your deductible for certain tiers. For example, you might have to pay towards your Medicare Part D deductible if your medication is a Tier 4 or 5 drug. If your medication falls under Tier 1, you might not have to pay towards your deductible.

When will I meet my Medicare Part D deductible?

Different people may meet their Part D deductibles at different times of the year. You could go through the year without ever meeting your deductible, if you don’t take many medications or they are low-cost prescription drugs.

The time it takes to meet your Medicare Part D deductible will also depend on your plan’s deductible amount. If your plan’s Part D deductible is the maximum amount of $415 for 2019, it might take you longer to pay that amount than if your plan has a lower deductible, like $200.

Once you meet your deductible, you may still have some costs for your medications. Some plans require you to pay a copayment or coinsurance every time you pick up a prescription. This also varies from plan to plan. Make sure you understand the additional expenses like copayments when you are comparing Medicare Part D plans.

You may want to compare deductibles and other plan costs when shopping for a Medicare prescription drug plan. Simply enter your zip code to get started.

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