Below is a high-level outline of the various stages of Part D plans: Stage 1 – Deductible (not all Part D plans have deductibles) Stage 2 – Initial Coverage Stage 3 – Coverage Gap is also known as the Donut Hole Stage 4 – Catastrophic Coverage Once you have spent $7,050 in out-of-pocket costs in 2022, you move out of the donut hole into stage 4 or catastrophic coverage. Once you reach the catastrophic coverage stage of your Part D drug plan, you will only have to pay low coinsurance or copays for covered drugs for the remainder of the year. You will pay either a 5% coinsurance or $3.95 copay for generic medications and $9.85 for brand-name, whichever is lower while in the catastrophic stage. It is important to remember that even if you are in the catastrophic coverage stage, a 5% coinsurance can still amount to significant out-of-pocket costs if your prescriptions are very expensive. Call Kevin Leinum – your local Medicare Expert about what Medicare covers or how enrolling in a Medicare Advantage or Medicare Supplement plan can improve your coverage and reduce your out-of-pocket costs.
