Medicare Part D 2016 Plan Year Stages

Medicare Part D Prescription Drug plans typically have four coverage stages. How you’re affected depends on your prescription drug plan and medication costs. If your plan has a deductible, you start at Stage 1. If your plan doesn’t have a deductible, you start at Stage 2. The dollar amounts listed below may change each year.

Medicare Part D Stage 1
  • You pay 100% of medication costs until you reach your annual deductible of $360.

*If you have the Humana Walmart Rx Plan, refer to your Summary of Benefits or Evidence of Coverage for specialized deductible information.

Medicare Part D Stage 1
  • Both you and your insurance plan pay medication costs until the shared total equals $3,310.
  • You’re generally responsible for copays and coinsurance during this stage.
Medicare Part D Stage 1
  • The coverage gap begins after you and your plan have spent $3,310 for covered drugs, and ends when you have spent $4,850 for the covered drugs.
  • While in this stage, you pay a maximum of 55% of the cost of brand name drugs, or a maximum of 42% of the cost of generic drugs.
  • The medication-related deductible, copays and coinsurance you paid in Stages 1 and 2 count toward the $4,850 limit.
  • The amount your plan paid in Stage 2 doesn’t count toward the $4,850 limit.

*If you have the Humana Enhanced plan, refer to your Summary of Benefits or Evidence of Coverage for specialized cost information.

Medicare Part D Stage 1
  • Catastrophic coverage begins when you reach the $4,850 coverage gap limit.
  • During this stage, you pay $7.40 for brand name or $2.95 for generic drugs, or 5% of your medication’s cost, whichever is greater.