Medicare Part D Supplemental Prescription Drug Changes in 2017

We know the last thing anyone wants to hear is that they are going to be paying more for their current healthcare coverage, but it is important that recipients stay informed and up to date on their Part D Plan benefit changes.

2017 changes to Medicare Part D include increases in our healthcare costs. What does that mean? Premiums, deductibles and co-payments will increase while fewer and fewer choices are available for Medicare Part D recipients.

2017 Medicare Part D Plans Available

It’s anticipated that only 750 plans will be made available to Medicare recipients within the United States during this year’s open enrollment period. Each year the amount of available Prescription Drug Plans diminishes this year it will put us at more than a 15% decrease from the previous year.

2017 Deductible, Initial Coverage Limit & Out of Pocket Threshold for Medicare Part D

Deductible: $400, a 10% increase from 2016

Initial Cover Limit: $3,700, a 10.54% increase from 2016

Out-of-Pocket Threshold: $8,071, a 2% increase from 2016 (Please note that this number varies depending on the use of brand name and generic drugs)

2017 Coverage Gap (Donut Hole)

The percentage Medicare Part D recipients are required to pay for a brand name drug has decreased. Once the recipient has reach the Initial Coverage Limit, they will only be required to pay 40% of the plans cost for brand name drugs and 51% of the plans cost for generic drugs.

2017 Catastrophic Coverage

Catastrophic Coverage begins once the recipient has reached the out of pocket threshold. This means that Medicare will then pay 80% of any remaining drug costs until the end of the year, while their prescription drug plan will cover 15%. Leaving the recipient responsible for the remaining 5% of cost.

Standard Benefit Design Parameters

Below you will find a table generated from Segal Consulting ( that compares the standard benefit design parameters for the Medicare Part D Changes from 2017 and 2016.

Standard Benefit Design Parameters 2016 2017
Deductible $360.00 $400.00
Initial Coverage Limit for Drug Expenses Paid by the Individual and the Part D Plan $3,310.00 $3,700.00
Out-of-Pocket Threshold Paid by Individual $4,850.00 $4,950.00
Total Covered Part D Drug Spending before
Catastrophic Coverage*
$7,062.50 $7,425.00
Minimum Copayment in Catastrophic Coverage Portion of Benefit for Generic/Preferred Multi-Source Drugs $2.95 $3.30
Copayment in Catastrophic Coverage Portion of Benefit for Other Drugs $7.40 $8.25

* Cost sharing for the catastrophic portion of the benefit is set at the greater of 5 percent coinsurance or fixed copayments set by CMS, which are shown in the last two rows of this table.

Affordable Care Act Prescription Costs in the Coverage Gap

The Affordable Care Act implemented substantial changes to the Medicare program, and the Medicare beneficiaries enrolled in a Medicare Part D Plans (PDP).  One of the more significant changes made is to the prescription drug costs in the coverage gap or donut hole. Medicare Part D recipients will be paying less out of pocket for their prescriptions each year until 2020. At which time the coverage gap will be eliminated.

Individual’s Responsibility for Prescription Drug Costs in the Coverage Gap
Year Brand-Name Drugs Generic Drugs
2016 45% 58%
2017 40% 51%
2018 35% 44%
2019 30% 37%
2020 25% 25%

*The 25 percent of drug costs that seniors will pay for both brand and generic drugs starting in 2020 is the same percentage of costs that seniors pay now during the initial coverage period.

Other Information

Other important information to note in the 2017 Medicare Part D Supplemental Prescription Drug Changes is that the CMS will begin monitoring the inappropriate use of medications, such as antipsychotics on patients suffering with dementia. Nursing homes and other community settings will be used to collect such information. Also, medications currently considered high risk that is unable to be monitored will no longer be included on the list of high risk medications.

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