Very few Medicare Part D plans keep their cost-sharing (co-payments and/or co-insurance) the same from year to year. Rather, your portion of your prescription costs has a tendency to rise. Some prescription drug plans have increased their cost-sharing more than others.
For example, the 2016 WellCare Simple (PDP) plan
- increased the co-payments for tiers one, two, and three;
- changed tier four from co-payment to co-insurance; and
- increased the co-insurance on tier 5 Specialty drugs.
WellCare Simple in Virginia
2015 and 2016 Medicare Part D plan Cost-sharing Comparison
|
|
2015 |
2016 |
Monthly Premium |
$31.90 |
$37.10 |
Initial Deductible |
$320 |
$360 |
Gap Coverage |
No Gap Coverage |
No Gap Coverage |
Tier |
2015
Cost-Sharing |
Drugs
on Tier |
Tier |
2016
Cost-Sharing |
Drugs
on Tier |
1 |
Preferred Generic
|
$0
|
289
|
1 |
Preferred Generic |
$8
|
323 |
2 |
Non-Preferred Generic |
$2 |
893 |
2 |
Generic |
$20 |
395
|
3 |
Preferred Brand |
$40 |
896 |
3 |
Preferred Brand |
$47 |
866 |
4 |
Non-Preferred Brand |
$88 |
621 |
4 |
Non-Preferred Brand |
50% |
771 |
5 |
Specialty Tier |
25% |
427 |
5 |
Specialty Tier |
33% |
446 |
Total Formulary Drugs
|
Browse 2015 Formulary |
3,135 |
|
Browse 2016
Formulary |
2,801 |
In reviewing the above example...
- Tier 1 preferred generic drug purchases that were free ($0) in 2015 will now cost members $8 as the pharmacy.
- Tier 2 non-preferred generics that cost $2 in 2015 will cost $20 in 2016.
- Tier 3 preferred brand-name drugs will cost $7 more in 2016 as compared to 2015.
- Tier 4 non-preferred brand-name drugs that have a retail price less than $176 will cost less in 2016 using the 50% co-insurance rather than the $88 co-pay from 2015. Example: a $120 prescription will only cost $60 rather than $88. However, prescriptions with a retail price over $176 will cost more in 2016. A $300 prescription will cost $150 using the 50% co-insurance rather than the $88 that it cost in 2015.
- Tier 5 specialty medications will cost 8% more than they did in 2015.
To compare annual changes in Medicare plans, our
PDP-Compare
and
MA-Compare
tools show the 2015 stand-alone Medicare Part D prescription drug plans
(PDPs) and Medicare Advantage plans (MAs or MAPDs) across the country and include changes in
plan features such as premium, deductible, cost-sharing and formulary
size changes. Our compare tools also highlight plans that will be merged, discontinued, or added in 2016.