PDP Out of Pocket Cap 2024

[somarco]

Starting January 1, 2024, once your out-of-pocket spending reaches $8,000 (including certain payments made by other people or entities, including Medicare’s Extra Help program, on your behalf), you’ll automatically get “catastrophic coverage.” This means you won’t have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year.

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/catastrophic-coverage

 

[kak6407]

pretty much in 2024 out of pocket will top out around $3300 for formulary drugs. In 2025 that will be $2000.

 

[straightnochaser]

Breaking news!

 

[kgmom219]

pretty much in 2024 out of pocket will top out around $3300 for formulary drugs. In 2025 that will be $2000.

I'm seeing $3400 to $3600 but...well...uhhh...I just KNEW that Inflation Reduction Act was going to be good for SOMETHING.

 

[kak6407]

I'm seeing $3400 to $3600 but...well...uhhh...I just KNEW that Inflation Reduction Act was going to be good for SOMETHING.

Ive seen that too. But a couple of times I have went directly to that carriers site and put in the meds and it comes back at $3300ish. I think connecture, medicare.gov, etc aren't always accurate on this. But who knows

 

[Duaine]

Medicare Math: 2024
Phase1 (deductible if applicable) you pay all cost. Phase 2 (initial coverage) you pay the cost sharing outlined in the plan you are in until your total drug costs reach $5030. Phase 3 (Coverage Gap) You pay 25% of the Plan's cost until your yearly Out-of-pocket drug cost reaches $8000. Phase 4 (catastrophic) you pay $0 co-pay for the remainder of the calendar year.

 

[somarco]

Mrs. Anderson reaches the coverage gap in her Medicare drug plan. She goes to her pharmacy to fill a prescription for a covered brand-name drug. The price for the drug is $60, and there's a $2 dispensing fee that gets added to the cost, making the total price $62. Mrs. Anderson pays 25% of the total cost ($62 x .25 = $15.50).

The amount Mrs. Anderson pays ($15.50) plus the manufacturer discount payment of $42 ($60 x .70 = $42) count as out-of-pocket spending. So, $57.50 counts as out-of-pocket spending and helps Mrs. Anderson get out of the coverage gap. The remaining $4.50, which is 5% of the drug cost ($3) and 75% of the dispensing fee ($1.50) paid by the drug plan, doesn't count toward Mrs. Anderson's out-of-pocket spending.

Costs in the coverage gap | Medicare

Medicare prescription drug coverage gap, aka the donut hole. People who get Extra Help paying Part D costs won't enter the coverage gap. Out of pocket costs help you get out of the coverage gap.

www.medicare.gov

The OOP cost to the beneficiary bears no relation to what the beneficiary pays for his or her meds.