Toni:

Last fall, I was diagnosed with a serious illness and began taking Humira, which is very expensive costing over $5,000 per month. I was told that the Medicare Part D “Donut Hole” was vanishing in 2020 and I would not have to pay more than I did in 2019.

This did not happen when I went to pick up my prescription at CVS after Jan. 1. I had to pay over $1,700 for the Humira and my diabetic insulin. I was under the impression that my prescriptions were not going to be as expensive as 2019. Can you please explain what has happened?

Shane from West U area

Shane:

77彩票网appThe “Donut Hole” is a stressful time for most Americans because the cost of your brand-name drug is simply more expensive. Now the Donut Hole is called the “Donut Hole” discount and that discount is 25 percent of the cost for both brand-name and generic prescriptions.

When Healthcare Reform began, the Donut Hole slowly began to close but was never intended to go completely away.

In the past, one had to pay 100 percent of the cost of the prescription for brand-name drugs when one would hit the “Donut Hole” and now the cost is a whopping 25 percent of the brand-name and generic drugs.

77彩票网appIt is amazing how the cost of prescriptions has increased. Maybe this is because, the prescription drug manufacturers and Part D plans have to pay a percentage to Medicare for the prescription. In 2020, the prescription drug manufacturer must pay 70 percent and the Medicare Part D plan must pay 5 percent and the Medicare beneficiary must pay 25 percent until the out-of-pocket cost reaches $6,350.

Below are the Medicare Part D costs before and after reaching the “Donut Hole” discount:

77彩票网appPart D changes for 2020 are:

 77彩票网app Initial Deductible: will be increased by $20 from $415 in 2019 to $435 in 2020.

  Initial Coverage Limit: will increase by $200 from $3,820 in 2019 to $4,020 in 2020 where the 2020 “Donut Hole” begins.

  Out-of-Pocket threshold cost: or () will increase from $5,100 in 2019 to $6,350 in 2020.

 77彩票网app Coverage Gap (Donut Hole): begins once you reach your Medicare Part D plan’s initial coverage limit ($4,020 in 2020) and ends when you spend a total of $6,350 out-of-pocket in 2020.

 77彩票网app Donut Hole Discount: Part D enrollees will receive a 75 percent on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes, a 70 percent discount paid by the brand-name drug manufacturer and a 5 percent discount paid by your Medicare Part D plan. The 70 percent paid by the drug manufacturer combined with the 25 percent you pay, count toward your TrOOP or Donut Hole exit point.For example: If you reach the Donut Hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your 2020 total out-of-pocket spending limit.

Be sure that all prescription drugs are covered on the new Part D prescription drug standalone or MAPD plan that you choose and enroll in for a 1st of the month effective date whether turning 65 or retiring past 65 and leaving employer benefits.

Workshop

A January 2020 Confused about Medicare Workshop will be held in west Houston/Katy from 6 to 8 p.m. Wednesday, Jan. 29, at Spring Creek BBQ-Katy in the Banquet Room (dinner will not be provided). The site is located at 21000 Katy Freeway, Katy, TX 77449. To RSVP call 832-519-8664 or visit tonisays.com and sign up via the Toni Says® website.

Toni King, author of the Medicare Survival Guide®, is giving a $5 discount on the Medicare Survival Guide® Advanced77彩票网app book to the Toni Says Medicare column readers at .