Medicare Part D changes coming in 2019

October 10, 2018


I recently received the “2019 Medicare and You” handbook did not find any information about what the the 2019 Part D deductibles and “Donut Hole” costs will be. I got in the “famous” Medicare donut hole this March.

I know it is only September, but I would like to get prepared and really cannot find the answer online or at the Medicare.gov website. Please inform me what the 2019 Medicare Part D costs will be. I look forward to what you have to say.

Karen, Clear Lake, TX


You are correct that the “2019 Medicare and You” handbook did not have the 2019 Part D deductibles or out-of-pocket maximums. It only says on page 77 that you will pay 25 percent of some amount for that year when in the Coverage Gap … aka Donut Hole.

But guess what?? For the Toni Says® Medicare newspaper column readers, we have a big surprise! Toni knows what the Medicare Part D costs, copays and Donut Hole will be for 2019.

The 2019 Medicare Part D costs and copays are explained below:

Initial Deductible: will be increased by $10 from $405 in 2018 to $415 in 2019.

Initial Coverage Limit: will increase by $70 from $3,750 in 2018 to $3,820 in 2019 where the 2019 “Donut Hole” begins.

Out-of-Pocket Cost: will also increase by $100 from $5,000 in 2018 out of pocket to $5,100 in 2019

Out of pocket: begins once you reach your Medicare Part D plan’s initial coverage limit ($3,820 in 2019) and ends when you spend a total of $5,100 in 2019. You will spend 25 percent of covered brand-name drugs, the drug manufacturer will pay 70 percent and the prescription drug plan will pay the remaining 5 percent of the covered brand name prescription. For generics in the donut hole, you will pay maximum 37 percent copay and the prescription drug plan will pay the remaining 63 percent.

Catastrophic Coverage: Once you have spent the Donut Hole quota for 2019 of $5,100, then you will enter Catastrophic Coverage where your “covered” generic prescription drugs copays are $3.40 or 5 percent of the “covered” generic prescriptions above $68 cost or for “covered” brand-name prescriptions the copays are $8.50 or 5 percent of the “covered” brand name prescription drugs above $170 cost.

Toni Says Reader Alert: If your prescriptions are not in your Part D formulary, then YOU WILL pay 100 percent of the prescription drug cost, which is why one must verify that all their prescriptions are in the specific chosen Medicare Part D formulary which can change every year.

Toni’s Tips to help you stay out of the Donut Hole or not get in it as soon:

1) Talk to your doctor or doctors about which brand-name drugs can be changed to generics.

2) Use your Medicare Part D plan for your brand-name drugs and expensive generics. You do not have to put every prescription on your Medicare Part D plan.

3) Visit ABBS4U.com for Toni’s 2019 Prescription Drug Survival Guide or visit Course No. 6 Medicare Prescription Drug Information and learn what your Part D options are.

Houston October Medicare/LTC Workshops

West Houston — Thursday, Oct. 18: 6-8p.m. at Spring Creek BBQ-Katy in the Banquet Room (dinner not provided) 21000 Katy Freeway, Katy, 77449 Please RSVP 832-519-8664.

SW Houston Area — Westbury Baptist Church, Saturday, Oct. 27: 10 a.m.-noon at Westbury Baptist Church, 10425 Hillcroft St., Houston, 77096. RVSP: 832-519-8664 as space is limited.

Facebook Live Event

“Facebook Live with Toni” about Medicare Part D Tuesday, Oct. 16, at 2 p.m. CST https://facebook.com/ToniKingSays.

Toni King, the author of Medicare Survival Guide® Advanced, is offering a Medicare Open Enrollment book package special at www.tonisays.com. For Medicare questions, email info@tonisays.com or call 832-519-8664.

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