Will Medicare Part D Prescription Drug Coverage Change in 2019?

Medicare Part D costs

Changes Coming in 2019 for Medicare Part D Plans

If you’re a Medicare enrollee who is covered by Part A for hospitalization, and Part B for doctors’ services, then you may also have a separate Medicare Part D drug plan that helps defray the costs of your covered prescription medications.

If you plan on keeping this coverage, though – as many Medicare beneficiaries do – then you need to know about some important upcoming changes to Medicare Part D that could affect your plan and your out-of-pocket costs.

The Medicare Part D “Donut Hole” is Closing

First, for the year 2019, there will some revisions to the Medicare Part D “donut hole.” What’s a donut hole?  Click here for a great primer article. 

Essentially, this refers to the Medicare Part D coverage gap, which consists of the period of time that you, the insured, must pay for your prescription medication, between the initial coverage limit and the catastrophic coverage threshold.

Not all Medicare Part D enrollees will enter the donut hole – which is essentially the time period after which you and your prescription drug plan have spent a certain amount for covered medications. For the year of 2018, this amount is $3,750.1

In 2019, this donut hole opening will close – albeit slightly – depending on the amount of your medication costs. For example, those Medicare enrollees who have high annual prescription drug costs could find a great deal of relief next year.

That’s because, starting in 2019, Medicare Part D beneficiaries will simply pay 25% of the cost of all of their prescription medications, from the time they enter the coverage gap, until the time that they reach the catastrophic coverage limit.

Changing Part D Coverage for Medicare Extra Help Enrollees

Another change impacting Medicare Part D for 2019 could impact those who are enrolled in Medicare Extra Help. This is a program that those who have limited financial resources and income may be able to qualify for.
With the Medicare Extra Help program, this includes assistance with paying the Part D monthly premiums, as well as the annual deductibles, and / or prescription copayments as they relate to Medicare Part D.

In order to qualify for Medicare’s Extra Help program, the following criteria must apply (in 2018):

  • You must reside in one of the fifty U.S. states or the District of Columbia;
  • Your financial resources must be limited to $14,100 for a single individual, or $28,150 for a married couple who live together. (In the case of the Extra Help program, resources include funds that are in savings and / or checking accounts, as well as investments like stocks and bonds. However, the value of your home, vehicle(s), and life insurance policy values are not included); and
  • Your annual income is limited to $18,210 for an individual or to $24,690 for a married couple who live together. (There are some exceptions that may apply with the income factor).
  • Beginning in January of next year, Extra Help beneficiaries will only be allowed to change their Medicare Part D prescription drug plans once per quarter during the first nine months of the year.

It is important to note even if you are eligible for Medicare’s Extra Help program for Medicare Part D coverage, if you do not enroll in a Part D prescription drug plan when you are initially eligible, it is possible that you will be penalized with a late enrollment charge.

In addition, you could be required to pay this penalty – which comes in the form of a higher Medicare Part D premium amount – for as long as you maintain your Medicare Part D prescription drug coverage.

Where to Go For More Information on Medicare’s Part D 2019 Changes

For additional details regarding the changes to Medicare Part D prescription drug coverage starting in 2019, you can visit Medicare’s website by going to www.Medicare.gov. You can also speak directly with an insurance professional who specializes in Medicare Part D plans.


Costs in the coverage gap. Medicare.gov (https://www.medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html)
Medicare “Doughnut Hole” Will Close in 2019. Medicare Resource Center. AARP. (https://www.aarp.org/health/medicare-insurance/info-2018/part-d-donut-hole-closes-fd.html)
Apply Online for Extra Help With Medicare Prescription Drug Costs. Social Security Administration. 2018. (https://www.ssa.gov/pubs/EN-05-10525.pdf)
2019 Means Changes to Medicare Advantage and Part D. By Kayla Pearce. MedicareWorld (https://medicareworld.com/2018/04/18/2019-means-changes-to-medicare-advantage-and-part-d/)

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Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.