Major Change to Medicare Part D in 2024?

Toni:

This year, I got into the Medicare “Donut Hole in July and got out of it in September. I am not sure what I will pay when I leave the Donut Hole? I can see from the Part D monthly statement that my prescription drug costs are exploding.

I’ve tried to research online the 2024 Medicare Part D cost, but it just confuses me. Please give me ideas to help control the Donut Hole cost or not get in it as fast!

Thanks, Miriam from Tulsa, OK

Miriam:

Your prescription drug problem is a typical Donut Hole problem since the cost of brand name prescriptions are exploding. This causes more on Medicare to get into the Donut Hole quicker. In 2024, Medicare has raised the Donut Hole to $5,030 which can help someone not get into it as fast. Who knows what prescriptions cost will be in 2024?

Miriam, when you left the Donut Hole in September, you entered what is called Catastrophic Coverage. For 2023, the cost is 5% of either brand name or generic drugs which you will pay for the remainder of this year. On pg. 83 of the 2024 Medicare & You handbook, it explains a major change to Medicare Part D Catastrophic coverage which will help control the costs of prescriptions for all who enter Part D’s final stage. The handbook states “Starting January 1, 2024, once your out-of-pocket spending reaches $8,000… you won’t have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year.”

2024 Medicare Part D costs are:

• Initial Deductible is $545.
• Initial Coverage Limit is $5,030 when the “Donut Hole”
• Donut Hole (Coverage Gap) begins once the Medicare beneficiary reaches the Medicare Part D plan’s initial coverage limit of $5,030 and ends when a total of $8,000 is out-of-pocket. The Medicare beneficiary will then be responsible for only 25% of the prescription drug cost while 70% is paid by the brand name/generic drug manufacturer and 5% paid by the enrolled Medicare Part D plan until the Donut Hole ends when the $8,000 exit point is reached.
• Catastrophic Coverage of $0 out of pocket begins January 1, 2024: when a Medicare recipient enters Catastrophic Coverage. Medicare will pick up all cost of the prescriptions whether brand name or generic and those with a Medicare Part D plan pay $0.

On January 1 of each year, the process starts all over again with a new Medicare Prescription Drug plan and different costs, deductibles, and a new Donut Hole.

Since October 1, when the 2024 Part D plans became available on Medicare.gov, Toni Says Medicare team has seen drastic changes to Part D costs to those with expensive brand name prescriptions. Here are some Toni Says Tips to help you stay out of the Donut Hole or not get in it as soon:

• Visit medicare.gov to view 2024 Medicare Part D and Medicare Advantage plans. The website has a tool for helping you narrow your search for new Medicare Advantage and Prescription Drug plans.
• Talk to your Primary Care and specialty doctors about which brand name drugs can be changed to generics.
• Get samples from your doctor.
• Search various Prescription drug programs such as GoodRx or Single Care for less expensive prescription drug costs. Wal-Mart, Kroger, HEB and Costco also have discount prescription drug plans.

Concerned about finding the “Right Medicare Prescription Drug Plan,” visit www.tonisays.com for Toni’s new Medicare Part D video series available to help you navigate the Medicare.gov website.

Call the Toni Says Medicare hotline for Medicare help at (832) 519-8664. Toni’s books are available at www.tonisays.com with a bundle discount for Toni Says® readers.