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Health Care Reform:

Health Insurance & Affordable Care Act

What Does Medicare Cost?

Medicare Part D

Part D is your prescription drug coverage.

Premium costs. The monthly fee you pay varies by the plan you choose. The average premium for the last several years has been about $30, and in 2015, the average is $33. If you have a higher income, you may pay more each month. In 2015, households with income of more than $170,000 or individuals with income greater than $85,000 pay on average $45 per month.

Deductible costs: Each year you pay a deductible before Medicare starts sharing the cost for your medicines. Although the deductible may vary from plan to plan, no plan may charge more than $320 in 2015. In 2016, the maximum will be $360.

After you've paid the deductible, your Medicare prescription drug plan kicks in and you pay a copay or coinsurance.

Out-of-pocket costs: The part you pay for your medicines is either called a copay or coinsurance. The amount depends on the plan you've chosen. You may pay more for some drugs than others, such as brand-name drugs.

Costs in the doughnut hole: If you spend a certain amount on medicines, you'll have a gap in your drug coverage, which is often called the doughnut hole.

While in the doughnut hole, in 2015 and 2016 you pay 45% of the cost for a brand-name medicine. This will steadily decrease until it reaches 25% in 2020.

For generic medicine, you pay 65% of the cost in 2015. This will steadily decrease to 25% in 2020.

You’ll Pay This Percentage for Brand-Name Drugs
in the Doughnut Hole
You’ll Pay this Percentage for Generic Drugs
in the Doughnut Hole
2013 47.5% 79%
2014 47.5% 72%
2015 45% 65%
2016 45% 58%
2017 40% 51%
2018 35% 44%
2019 30% 37%
2020 25% 25%

After the total cost of your drugs (what you and your health plan paid combined) reaches a certain level, Medicare stops paying for them. In 2013, that level is $2,970. For 2014, it will be $2,850.

Although you have to start paying your drug costs on your own, you receive a 55% discount for covered brand-name drugs. That means you pay 45% of the drug's cost. Prescription drug plans will pay 35% of the cost of covered generic drugs . That means you pay 65% of the cost of generic drugs that are covered by Medicare.

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