One of the biggest Medicare changes in years is now fully in effect: if you have a Medicare Part D prescription drug plan, the most you’ll pay out of pocket for covered drugs in a calendar year is capped at $2,000. Once your out-of-pocket spending reaches that limit, you pay $0 for covered prescriptions for the rest of the year.
For people taking several medications — or even one or two high-cost specialty drugs — this can mean thousands of dollars in savings compared to a few years ago, when there was no annual ceiling at all.
Who benefits most
- Anyone on multiple ongoing medications
- People taking a high-cost brand-name or specialty drug
- Beneficiaries who previously hit the old “coverage gap” (donut hole) every year
A couple of things to know
The cap applies to covered drugs under your plan’s formulary, so the specific plan you choose still matters. You can also spread your costs across the year with the Medicare Prescription Payment Plan instead of paying large amounts up front.
Not sure your current plan covers your drugs the most affordable way? Our Drug Cost Calculator gives you a quick estimate, and a free plan review checks whether a different Part D plan would save you money. Questions? Talk to Bret — no cost, no pressure.
Source: Based on information from cms.gov. Coverage details depend on your specific plan and can change — always confirm with your plan or a licensed agent.