Good News: Part D Donut Hole Closes in 2020

For stand-alone Part D prescription drug plans, the maximum allowable deductible for standard Part D plans will increase to $435 in 2020, up from $415 in 2019. The out-of-pocket threshold (where catastrophic coverage begins) will increase significantly, from $5,100 in 2019 to $6,350 in 2020 (the copay amounts for people who reach the catastrophic coverage level will also increase slightly in 2020).

The good news is that the Affordable Care Act has gradually been closing the donut hole in Medicare Part D. As of 2020, there will no longer be a “hole” for brand-name or generic drugs. Enrollees in standard Part D plans will pay 25% of the cost (after meeting their deductible) until they reach the catastrophic coverage threshold. Prior to 2010, enrollees paid their deductible, then 25 percent of the costs until they reached the donut hole, then they were responsible for 100 percent of the costs until they reached the catastrophic coverage threshold.

The donut hole closed one year early — in 2019, instead of 2020 — for brand-name drugs (so enrollees in standard plans paid 25% of the cost of brand-name drugs from the time they met their deductible until they reached the catastrophic coverage threshold). Now, in 2020 enrollees will pay 25% percent of the cost of generic drugs down from 37% in 2019.

Call me today for help learning how this year’s changes may affect you.