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Parameters for 2017 Medicare Part D “prescription drug plan coverage” finalized standard

CMS Centers for (Medicare and Medicaid) Services had released their Rate Announcement for 2017, a Final Call Letter which has the defined standard benefits, finalized for 2017’s Medicare, Part D “Prescription drug plan coverage” or referred to as (Final Updated Part D Benefit Parameters for Defined Standard Benefit). This establishes the values for 2017’s initial coverage limit, deductible, as well as the Donut Hole limits for the standard Part D plans.

Here is a brief summary for some standard Medicare, Part D prescription drug coverage which was published in the letter for finalized CMS Announcement.

  • 2017 Increase for standard Initial Deductible is to increase $40 making it $400. Currently for 2016 is $360, 2015 was $320 for the Deductible. If enrolling in Part D with a standard initial deductible in 2017 you will pay a bit more before the drug plan coverage starts to pay.
  • Limit for the Initial Coverage is increasing $390, so 2017 will increase to $3,700. In 2016 this limit was $3,310, and in 2015 it was $2,960. This amount is when the total retail value of their prescription drug purchases reaches the Initial Coverage limit, known as the “Donut Hole” or (Coverage Gap). When purchasing medications averaging $309.00 each month and has a retail value greater than $309 each month then you come into the (Donut Hole) for 2017.
  • Generic drugs Donut Hole discounts is increasing for the 2017. If you reach the (Coverage Gap phase) or the Donut Hole next year for your Part D plan Medicare coverage. Generic drug discount is increasing from 42% up to 49%.
  • Increase discount with the Donut Hole for Brand Name Drugs. This will be increasing to 60%. 2016 discount was 55%. You will also receive a 90% credit of retail drug cost which goes toward your total out of pocket maximum for 2017 or your Donut Hole exit point ($4,950) which is the 40% spent in addition to the 50% drug manufacturer discount.
  • TrOOP – Total Out of Pocket Costs is increasing $100. The TrOOP amount is what is needed to be spent in order to get out of the Coverage Gap and / or Donut Hole. This is not including the monthly premiums. This means the $100 increase totals at $4,950 as opposed to the 2016 valued amount of $4,850. 2015 threshold was valued at $4,700. A 90% credit of your retail drug price will go toward meeting the TrOOP threshold for 2017.