Part D Costs for Those NOT Receiving Extra Help
Medicare announced Part D and Extra Help costs earlier this year. A Medicare beneficiary who does not qualify for any level of Extra Help from Medicare will pay the following costs for a standard* Part D Plan in 2023:
- The plan’s monthly premium (the national Part D base beneficiary premium will be $32.74);
- An annual deductible of $505;
- During the initial coverage period, a 25% co-pay for each covered prescription until the person’s total drug costs reach $4,660;
- After the initial coverage period, a person will continue to pay 25% of the cost of both brand-name and generic drugs (plus a small dispensing fee) until the consumer’s total out-of-pocket expenses reach $7,400; and
- During the catastrophic coverage period, a co-pay of $4.15 for generics and $10.35 for brand name drugs, or a 5% co-pay, whichever is greater, for the rest of the year.
* Part D plans can structure their benefits differently as long as their costs are actuarily equivalent to the costs Medicare outlines in their standard Part D benefit. Most Part D plans structure their cost-sharing differently from the standard coverage by lowering or taking away the deductible and placing drugs on tiers with drugs on lower tiers costing less than drugs on higher tiers.
Anyone who qualifies for the full amount of Extra Help from Medicare will have the following costs in 2023 (this includes all dual eligibles who have Medicare and who receive any benefit from Medicaid, including payment of the Medicare Part B premium):
- $0 premium (as long as she enrolls in a Part D plan that provides standard benefits and charges a premium below the 2023 Extra Help Benchmark for Pennsylvania which is $41.08).
- Small co-pays for their prescription medications:
- $1.45/generics and $4.30/ brand names (if income is less than 100% FPL) or
- $4.15/generics and $10.35/ brand names (if income is above 100% FPL) or
- $0 if someone is on Medicare and receiving Medicaid long term care services in a nursing home or through a Home and Community-Based Services Waiver program
Those beneficiaries who qualify for partial Extra Help in 2023 will pay the following costs:
- A portion of their Part D plan monthly premium depending on the amount of their Extra Help;
- A deductible no higher than $104;
- 15% co-pays on all of their medications until they reach total out-of-pocket expenses of $7,400;
- During the catastrophic coverage period, co-pays of $4.15/generics and $10.35/name brands for the rest of the year