Medicare Part D Beneficiaries May Pay Less for Prescriptions in 2018

Question: What will be happening with the Medicare Part D doughnut hole in 2018? Will it continue to close?

Answer: The Medicare Part D doughnut hole -- the coverage gap in Medicare prescription-drug coverage in which you pay a larger portion of the drug costs out of pocket -- will continue to close next year. In 2017, people with Part D pay 40% of the cost of brand-name drugs in the coverage gap and 51% of the cost of generic drugs. In 2018, you'll pay 35% of the cost of brand-name drugs in the coverage gap and 44% of the cost of generic drugs. The doughnut hole will continue to shrink each year until 2020, when you'll only need to pay 25% of the cost of brand-name and generic drugs in the coverage gap.

For 2018, after you pay a deductible of up to $405 (the deductible amount varies by plan), your Part D plan will provide coverage until your drug expenses reach $3,750 (including both your share and the insurer's share of the costs). Then you will land in the doughnut hole, and your out-of-pocket cost will be 35% of brand-name drugs (50% of the discount for brand-name drugs will be covered by the drug company, and your plan will pay 15%) and 44% for generics (a 56% discount for generics will be a federal subsidy). For example, if your generic drug costs $100, you'll pay $44, and the government subsidy will cover the remaining $56. When your out-of-pocket costs reach $5,000, your plan will pay 95% of your drug costs and you'll just pay the remaining 5%.

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Even though the pharmacy applies the discount in the doughnut hole automatically, both the 35% you pay and the 50% discount the drug company pays for brand-name drugs (but not the 15% paid by your plan) will count toward your $5,000 out-of-pocket cost cutoff. For generics, only the 44% you pay will count toward your out-of-pocket costs.

For more information, see Medicare.gov's Closing the Coverage Gap.

Open enrollment runs from October 15 to December 7 to pick a Medicare Part D plan or Medicare Advantage plan for 2018. You can now compare premiums and coverage for the 2018 plans in your area with the Medicare Plan Finder. (Medicare Advantage plans are called "Medicare Health Plans" in the tool.)