What to Expect for Medicare Part D Premiums in 2019


Medicare Part D refers to the optional prescription drug coverage that many get to supplement the Parts A and B of Original Medicare. Every year, you can probably expect changes to Medicare Part D prescription plan coverage, and it’s no different in the coming 2019.

If you subscribe to a Part D plan, here are some changes that you should anticipate:

Lower Premiums

This may be a surprise for some, as every year we tend to see that prices of premiums always go up. However, new CMS (Centers for Medicare & Medicaid Services) policies have been enacted as part of a broader HHS (Health and Human Services) to lower the cost of prescription drugs for patients.

In 2018, the average premium for Part D plans is $33.59 per month. That’s expected to slightly go down to $32.19 on average for 2019. It may not be much, but at least it’s a reduction.

However, those who earn at least half a million dollars a year will have their Part B and Part premiums increase by about 85%.

Deductibles Will Increase

The deductible is what you have to pay for yourself before the insurance plan kicks in and pays for part of the expenses. The current standard deductible for 2018 is $405, and that will be $415 in 2019.

This isn’t surprising, as the standard initial deductible was $400 in 2017, $360 in 2016, and $320 in 2016. An increase of $10 is definitely better than a $40 jump in deductibles.

Greater Initial Coverage Limit

In 2018, the coverage limit is $3,750 and for 2019 it will increase by $70 to $3,820. At least now you have a greater limit before you enter the “donut hole” Part D coverage gap, at which point you pay a lot more for prescription drugs.

Enhanced “Donut Hole” Coverage for Generic and Brand Name Drugs

The good news is that for 2019 you will pay somewhat less for your generic drugs. The 56% discount for generics in 2018 will become 63% in 2019. The generic drug purchases will also count as part of your out-of-pocket spending limit for 2019.

For brand name medications, the discount for 2019 will be 75% off retail. This means you pay for just 25% of the original cost of the brand name drug. In addition, the new policies also specify that 95% of the cost of the drug will be applied to your out-of-pocket spending limit.

So if the brand name drug costs $100, you only pay $25. Yet your spending limit total will be credited with a payment of $95 for that drug.

Greater Total Out-Of-Pocket Cost

The total out-of-pocket cost is the amount you reach in payments after which the insurance plan increases the percentage of its payments for prescription drugs. Right now this cost limit is $5,000 but in 2019 it will be increased slightly to $5,100.

Higher Catastrophic Coverage

Exiting the “donut hole” gap lets you into the catastrophic coverage stage of your Part D plan. For 2019, the costs of the drugs in this stage will be slightly higher. In 2018, you have to pay at least $8.35 for a brand name drug but in 2019 the price will be at least $8.50. For generic drugs, the 2018 price of $3.35 per drug will be slightly raised to $$3.40 per drug.

You should monitor the news regarding any other changes to Medicare plans that may be enacted this year for the coming 2019. CMS will post the final standard premium rates for all Medicare health plans by around September of 2018.

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