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What happens when a person reaches the Medicare Part D deductible?

It is important to understand that not all patients have an annual deductible, so the observations in this post refer only to those who do pay a deductible. Once that deductible limit has been reached, what usually happens is that the patient then has to pay a co-insurance or co-payment for every prescription. Co-payments are typically a fixed dollar amount. Co-insurance payments have the individual pay a percentage of the total cost of the drug.

Medicare Part D also has what is referred to as catastrophic coverage. If a patient’s annual out-of-pocket reaches $4,950 (2017), only a small co-payment or co-insurance amount is paid for all covered drugs for the balance for the year.

If you qualify as low income Medicare Part D has an Extra Help provision that may help an individual or family reduce drug costs even more. Those who qualify do not pay more than $3.30 per covered generic drugs or $8.25 for a brand name covered drug.

Want to find your level of possible Extra Help? Visit the Medicare website at: