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Understanding Medicare Part D's Catastrophic Coverage Phase
Once your drug costs cross a certain threshold, your cost-sharing changes significantly.
Talk to a Licensed Agent: (302) 407-0876How the Catastrophic Phase Works
Part D drug coverage is structured in phases based on how much you and your plan have spent on covered drugs during the year. Once your true out-of-pocket spending crosses the annual threshold, you move into the catastrophic coverage phase for the rest of the plan year.
Part D has also been redesigned in recent years to add a firm annual out-of-pocket cap, after which covered drug costs are $0 for the remainder of the year — a significant change from the older structure that included a 5% coinsurance requirement even in the catastrophic phase. Check Medicare.gov for the current year's exact out-of-pocket cap amount, since it's adjusted annually.
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Call (302) 407-0876Managing Costs Before You Get There
Specialty medications for conditions like cancer, autoimmune disease, or Hepatitis C tend to drive people toward the catastrophic phase fastest, since they're often the most expensive drugs on a formulary.
To manage costs along the way, review your plan's formulary every Annual Enrollment Period, ask your doctor about lower-cost generic alternatives where appropriate, look into manufacturer copay assistance programs for specialty drugs, and stick to in-network pharmacies.
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