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Medicare Part D 2023
Here are the highlights for the CMS defined Standard Benefit Plan for 2023. The “Standard Benefit Plan” is the minimum allowable plan to be offered.
Cost Sharing may change depending on the pharmacy you choose and when you enter a new phase of the Part D benefit.
Initial Deductible: $505 The amount you pay before a plan covers your prescription drug costs.
Initial Coverage Limit: $4,660
During this stage, the plan pays its share of the cost and you pay your share. You are in this stage until your payments and the plan’s payments total $4,660 for the year.
Coverage Gap (“donut hole”)
When your drug costs and plan payment for the year reach $4,660, you enter the Coverage Gap Stage (donut hole). You will pay 25% of the cost for formulary brand-name and generic drugs. You will stay in this stage until your out-of-pocket costs for the year reach $7,400.
Catastrophic Coverage After your out-of-pocket costs for prescription drugs reach $7,400, the plan will pay most of your drug costs for the rest of the year. You will pay either 5% of the cost of the drug, or a co-pay of $4.15 for generic drugs or $10.35 for all other drugs.
Medicare Part D Income-Related Monthly Adjustment Amounts
|
Beneficiaries who file individual tax returns with modified adjusted gross income: |
Beneficiaries who file joint tax returns with modified adjusted gross income: |
Income-related monthly adjustment amount |
|
Less than or equal to $97,000 |
Less than or equal to $194,000 |
your plan premium |
|
Greater than $97,000 and less than or equal to $123,000 |
Greater than $194,000 and less than or equal to $246,000 |
12.20 + your plan premium |
|
Greater than $123,000 and less than or equal to $153,000 |
Greater than $246,000 and less than or equal to $306,000 |
31.50 + your plan premium |
|
Greater than $153,000 and less than or equal to $183,000 |
Greater than $306,000 and less than or equal to $366,000 |
50.70 + your plan premium |
|
Greater than $183,000 and less than $500,000 |
Greater than $366,000 and less than $750,000 |
70.00 + your plan premium |
|
Greater than or equal to $500,000 |
Greater than or equal to $750,000 |
76.40 + your plan premium |
Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:
|
Beneficiaries who are married and lived with their spouses at any time during the year, but file separate tax returns from their spouses, with modified adjusted gross income: |
Income-related monthly adjustment amount |
|
Less than or equal to $97,000 |
your plan premium |
|
Greater than $97,000 and less than $403,000 |
70.00 + your plan premium |
|
Greater than or equal to $403,000 |
76.40 + your plan premium |