2022 Part D Standard Plan Cost-Sharing* Part D Benefit Cost Periods Costs and Who Pays Beneficiary Pays (TrOOP) Plan Pays Total Amount Spent on Plan-Covered Drugs Inial Deducble Beneficiary pays 100%. Up to $480 $0 $480 (Amount spent on deducble before ICP begins) Inial Coverage Period (ICP) Costs of covered drugs are shared: 25% by beneficiary, 75% by plan. Up to $1,107.50* *maximum an individual would pay if in plan with no deducble $3,322.50 $4,430 (Amount spent during ICP, including applicable deducble, before Coverage Gap begins) Former Coverage Gap (“Donut Hole”) While the Part D coverage gap (“donut hole”) officially closed in 2020, that does not mean beneficiaries don’t have to share a poron of costs aſter the ICP: • The beneficiary will connue to pay 25% for both generic drugs and brand-name drugs, plus a small poron of the pharmacy dispensing fee (approx. $1-$3). • The plan pays 75% of the cost of generic drugs and 5% for brand-name drugs. • The drug manufacturer provides a 70% discount on brand-name drugs. Note about True Out-of-Pocket (TrOOP) costs: The total amount spent in this period (up to $5,582.50) includes: • The drug costs paid by the beneficiary, and • The 70% discount on brand-name drugs provided by the drug manufacturer. Payments made by the plan during this period (75% on generics, 5% on brand-name drugs) do not count toward TrOOP. Up to $5,582.50 (Total amount spent during the period between the end of the ICP and prior to the Catastrophic Benefit Period) $10,690.20 (Total amount spent during both the ICP and this period, before Catastrophic Benefit Period begins) Catastrophic Benefit Period When an enrollee’s total out-of-pocket spending reaches $7,050, they hit the catastrophic benefits period, and costs of covered drugs are shared. Beneficiary pays reduced copay/coinsurance; plan pays the difference. Greater of: 5% coinsurance OR $3.95 copay for generic, $9.85 copay for brand or non-preferred. Any remaining poron of the negoated drug price. Beneficiary will remain in the Catastrophic Benefit Period through December 31, 2022. Part D benefit will reset on January 1, 2023, starng again with a deducble. *Most Part D plans are not standard plans. This means calculang TrOOP (True Out-of-Pocket) costs during the inial deducble and ICP varies by plan. Contact SHIIP at 1-800-259-5300
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2022 Part D Standard Plan Cost-Sharing*Part D Benefit Cost
Periods Costs and Who Pays Beneficiary Pays (TrOOP) Plan Pays Total Amount Spent
on Plan-Covered DrugsInitial
DeductibleBeneficiary pays 100%. Up to $480 $0
$480 (Amount spent on deductible before ICP begins)
Initial CoveragePeriod (ICP)
Costs of covered drugs are shared: 25% by beneficiary, 75% by plan.
Up to $1,107.50**maximum an individual would pay if in plan with no deductible
$3,322.50
$4,430 (Amount spent during ICP, including applicable deductible, before Coverage Gap begins)
FormerCoverage Gap
(“Donut Hole”)
While the Part D coverage gap (“donut hole”) officially closed in 2020, that does not mean beneficiaries don’t have to share a portion of costs after the ICP:
• The beneficiary will continue to pay 25% for both generic drugs and brand-name drugs, plus a small portion of the pharmacy dispensing fee (approx. $1-$3).
• The plan pays 75% of the cost of generic drugs and 5% for brand-name drugs.• The drug manufacturer provides a 70% discount on brand-name drugs.
Note about True Out-of-Pocket (TrOOP) costs:The total amount spent in this period (up to $5,582.50) includes:• The drug costs paid by the beneficiary, and• The 70% discount on brand-name drugs provided by the drug manufacturer.
Payments made by the plan during this period (75% on generics, 5% on brand-name drugs) do not count toward TrOOP.
Up to $5,582.50 (Total amount spent during the period between the end of the ICP and prior to the Catastrophic Benefit Period)
$10,690.20 (Total amount spent during both the ICP and this period, before Catastrophic Benefit Period begins)
CatastrophicBenefit Period
When an enrollee’s total out-of-pocket spending reaches $7,050, they hit the catastrophic benefits period, and costs of covered drugs are shared. Beneficiary pays reduced copay/coinsurance; plan pays the difference.
Greater of:
5% coinsurance OR $3.95 copay for generic, $9.85 copay for brand or non-preferred.
Any remaining portion of the negotiated drug price.
Beneficiary will remain in the Catastrophic Benefit Period through December 31, 2022.
Part D benefit will reset on January 1, 2023, starting again with a deductible.
*Most Part D plans are not standard plans. This means calculating TrOOP (True Out-of-Pocket) costs during the initial deductible and ICP varies by plan.
Contact SHIIP at 1-800-259-5300
This public document is published at a total cost of $749.22. 3,000 copies of this public document were published in this first printing at a cost of $734.94. The total cost of all printings of this document including reprints is $749.22. This document was published by OTS-Production Support Services, 627 N. 4th St., Baton Rouge, LA 70802 for the Louisiana Department of Insurance to provide senior citizens with Medicare information under the authority of 42 USC 1395b-4. This publication was supported by the Louisiana Department of Insurance with financial assistance, in whole or in part, through a grant from the Administration for Community Living. This material was printed in accordance with standards for printing by state agencies established in R.S. 43:31. Printing of this material was purchased in accordance with the provisions of Title 43 of the Louisiana Revised Statutes.
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