Medicare Supplements                     Medicare Advantage                  Medicare Part D

Home >> Texas Medicare Part D >> Part D Basics

Texas Part D Basics

Understanding the Coverage Gap

Medicare Part D drug plans have four stages of coverage during each calendar year. During each stage, you are responsible for a portion of your drug costs, depending on which drug plan carrier you choose.

The stages are as follows:

Annual Deductible: You pay the first $320 in drug costs (in 2012)

Initial Coverage Level:  You pay a copay or coinsurance amount for each drug, and the plan pays the rest of the cost up until the total costs of your prescriptions filled (including what you have paid AND what the insurance company has paid) has reached $2,930 (in 2012)

Coverage Gap (Donut Hole): In 2012, you will pay 50% of the cost of your brand name Part D medications in the coverage gap.  You will get a 14% discount on generic drugs as well because you belong to a Medicare drug plan.

Catastrophic Coverage: Once the total cost of your approved Part D medications (including what the insurance company has paid) reaches $4700 in one calendar year, the coverage gap ends and you enter catastrophic coverage. You then only pay 5% or less for each prescription drug until the end of the year.

Choosing Your Part D Plan

All insurance carriers offering Texas Part D drug plans must include the minimum coverage outlined above. However, many carriers offer richer plans, such as plans that waive the deductible, for an extra premium.

Each carrier also sets it's own pricing, formulary and copays every year, too, so it's important to research which plan offers you the lowest out of pocket costs for your specific RX needs.

Medicare Part D drug spending is tracked by the carrier you are insured with. If you move to a new county and have to change plans mid-year, the amount you have spent transfers with you to the new carrier and they continue the tracking.

For help understanding Texas Medicare Part D Prescription Drug Plan options, please fill out our online help request: 
Texas Medicare Part D quote form.