Part D Medicare 2016

Florida Medicare Part D 2015 Plan Benefits  - Standard
Florida Part D Medicare 2016 plans must cover at least the Part D standard benefit or its actuarial equivalent.

For 2016, the standard benefit requires the beneficiary to pay:taking prescription pill with milk

  • $360 deductible
  • 25% of prescription drug costs between $360 and $3,110 = $738
  • Part of the costs in the “Coverage Gap” (also known as the donut hole) - After total spending on drugs by the beneficiary and the plan reaches $3,110 ($2,960 in 2015) the beneficiary pays for 58% of generic drug costs and 45% of brand name brand drug costs (undiscounted).

→  Drug manufacturers provide a 50% discount on brand name drug costs.
→  In 2010 a new law was enacted that will eliminate the coverage gap by 2020.  This will be done by reducing the amount beneficiaries pay while in the coverage gap by a small percentage each year until 2020 when they will be responsible for only 25% of brand and generic drug costs.

  • Nominal costs under catastrophic coverage: Once the beneficiary expenditures (including drug manufacturer discounts) reach a total of $4,850 ($4,700 in 2015), the beneficiary is through the coverage gap and reaches catastrophic level coverage. On any future prescriptions the beneficiary pays either a co-pay of $2.95 for generic drugs or $7.40 for brand name drugs or a co-insurance of 5%, whichever is greater.

The Medicare Part D benefits must be at least as good as the standard coverage.  Some Part D plans have enhanced coverage for an additional monthly premium.  Some Part D plans will have no deductibles as well.