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Part D Deductible Explained

what is medicare part d deductible

Some Part D plans have a deductible and some do not. Part D plans with a deductible tend to have a lower premium than those that do not.

Should you choose a Part D plan with a deductible? Most clients’ eyes glaze over as I explain how the deductible works.  And I’ve gotten calls from clients who forgot about the deductible in their Part D plan and wondered why they paid such a high price for a drug.

I have quite a few clients who signed up for a Medicare supplement and needed a stand-alone Part D plan – even though they take no drugs, or just a couple of generics.  They could pay $30 or more for a Part D plan that has no deductible, and they would pay $4 to $15 for their generics. The crazy thing is that they could buy those generics for $4 to $8 without Part D.

But these folks know that, while Part D is “voluntary “, there is a penalty for people who don’t enroll in a plan and then later find out they need the coverage. So I tell them they should pay the lowest premium just to be in the Part D system. And the lowest-cost Part D plans have a deductible.

In 2014, the standard deductible is $310 for Part D plans that have a deductible. These plans have monthly premiums that range from $12.60, or $19 to $30. I don’t know why a person would pay a higher price for a plan with a deductible when you can pay $34 for a plan without one.

An example of Part D confusion

I had a client call me about what she and her husband paid for the Shingles vaccine. They have different Part D plans. Her plan has a deductible, and his plan does not. At that time her plan cost $15.10 per month, and his cost $28.60 (in 2012).  She paid $166 for the

Shingles vaccine and he paid $95.

The husband’s plan had a $45 co-pay for “preferred brand” drugs. It had a $95 co-pay for “non-preferred brand” drugs. I looked up Zostavax in his Part D plan formulary. Sure enough, Zostavax is a “non-preferred” brand drug on his plan.

The wife’s plan had a $320 deductible (in 2012). I checked her plan formulary and the retail price for Zostavax is $166. Because she paid the full retail price, this meant she had not yet met her plan deductible.  She takes two generics that probably cost $4 per month, so that will not add up to $320 throughout the year – so she will never meet her deductible. Although, now she has paid $166 toward that deductible because of the Zostavax.

The wife asked me, “Why am I not in the same plan as my husband?”. I had to remind her that we had discussed her drug costs and options when she first enrolled in her plan. I reminded her that she got her Part D plan pretty much to be in the Part D system. I also explained to her that, if she had already met her deductible, her co-insurance for the Zostavax would have been just 20% of $166, or $33.

So, I tell people who don’t really need a Part D plan that they have some choices: 1) Don’t enroll in Part D; 2) Pay a higher monthly premium for a plan with no deductible – which is paying a high price for something they don’t even need; 3)  Pick the plan with the lowest premium – but that plan will have a deductible.

This deductible question is just one of the many things that make Medicare Part D confusing. I always end my post on Part D with the question: Why did the Powers-That-Be make Part D so complicated?


Category: Insurance

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