CMS Announced changes to Part D of Medicare in 2017

These are the highlights for the CMS defined Standard Benefit Plan changes from 2016 to 2017

• Initial Deductible- will be increased by $40 to $400 annually in 2017
• Initial Coverage Limit- will increase from $3,310 to $3,700
• Out-of-Pocket Threshold- will increase from $4,850 to $4,950
• Coverage Gap, also known as (donut hole)- begins once you reach your Medicare Part D plan’s initial coverage limit ($3,700 in 2017) and ends when you spend a total of $4,950. Part D enrollees will receive 60% discount on the total cost of their brand name drugs purchased while in the donut hole. The 50% discount paid by the brand name drug manufacture will apply to getting out of the donut hole, however the additional 10% paid by your TrOOP (True out of pocket cost).

For Example: If you reach the donut hole and purchase a brand name medication with retail cost of $100, you will pay $40 for the medication and receive $90 credit toward meeting your 2017 total out of pocket spending limit.

Enrollees will pay maximum of 51% co-pay on generic drugs purchased while in the coverage gap (a 49% discount).

For Example: If you reach the 2017 donut hole and your generic medication has a retail cost of $100, you will pay $51. The $51 that you spend will count toward your TrOOP.

• Minimum Cost-Sharing in the Catastrophic Coverage Portion of the Benefit- will increase to the grater of 5% or $3.30 for generic or preferred drug that is multi-source drug and the grater of 5% or $8.25 for all other drugs in 2017.
• Maximum Co-Payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees- will increase to $3.30 for generic or preferred drug that is multi-source drug and $8.25 for all other drugs in 2017.