What REALLY happens when the donut hole goes away?

[somarco]

Confession. I haven't paid much attention to the Part D changes for 2020 since it is a LONG time off. Except now it is almost around the corner.

What REALLY happens in 2020?

Read recently that the donut hole doesn't go away, it is simply "absorbed" into the pricing. I more or less figured that, come 2020 premiums and copay's will rise.

But I believe I read that there won't be any copay's, only coinsurance percentages.

And you still have initial coverage then (something else) followed by catastrophic.

So what will 2020 PDP's look like?

 

[WCMason]

Confession. I haven't paid much attention to the Part D changes for 2020 since it is a LONG time off. Except now it is almost around the corner.

What REALLY happens in 2020?

Read recently that the donut hole doesn't go away, it is simply "absorbed" into the pricing. I more or less figured that, come 2020 premiums and copay's will rise.

But I believe I read that there won't be any copay's, only coinsurance percentages.

And you still have initial coverage then (something else) followed by catastrophic.

So what will 2020 PDP's look like?

Technically the Coverage Gap doesn’t go away; it just goes down so it’s effectively eliminated relative to the initial stage. There will still be three stages as now (Initial, Gap, Catastrophic). In 2020 the member cost in the Gap will be 25%, with the carrier and drug company discount picking up the rest as now. The initial and catastrophic stages stay in place.

 

[somarco]

In 2020 the member cost in the Gap will be 25%,

25% of . . . retail . . . whatever that is . . .

Seems kind of open ended. Kind of like "trust me".

What could possibly go wrong?

 

[WCMason]

25% of full cost of the drug. Like now but lower %.

 

[somarco]

25% of full cost of the drug. Like now but lower %.

Yeah, I get that it is retail. You missed my subtlety.

Real question is, how much is retail?

This old drug was free. Now it's $109,500 a year.

 

[Newby]

I was thinking the donut hole co-pay eventually ends up at 20%. Could be wrong.

 

[Chazm]

It’s 25% but yeah it’s all BS. Drug prices will just keep on rising so there’s no real savings.

 

[somarco]

If you like your drug plan you can keep your drug plan . . .

 

[kgmom219]

Its a crapshoot. There are too many variables, with the 3 different contracts that control the pricing. And who knows what DC is going to do next.

 

[axeman462]

Its a crapshoot. There are too many variables, with the 3 different contracts that control the pricing. And who knows what DC is going to do next.

This is pretty much what I have been thinking and telling clients when it comes up. Everything is just speculation until it actually happens.

Everything related to Medicare is controlled by politics, and 2020 is still 2 years and one more election cycle away... That is a lifetime in politics and a lot can still happen/change.