| Part D Benefit Cost Periods | Costs and Who Pays | Beneficiary Pays (TrOOP) | Plan Pays | Total Amount Spent on Plan-Covered Drugs |
| Initial Deductible | Beneficiary pays 100% | Up to $615 | $0 | $615 (Amount spent on deductible, before ICP begins) |
| Initial Coverage Period (ICP) | Costs of covered drugs are shared: 25% by beneficiary, 75% by plan | Up to $1,485 (max a person would pay for covered drugs with no deductible) | $4,455 | $2,100 True Out-of-Pocket (TROOP) maximum (Includes what the beneficiary pays plus the 10% manufacturer discount on brand-name drugs during the Initial Coverage Phase.) |
| Catastrophic Benefit Period | When an enrollee’s total out-of-pocket spending reaches $2,100, they hit the catastrophic benefits period. After this point, the beneficiary does not have to pay anything for their prescription drugs for the rest of the year. | $0 | 100% | Beneficiary will remain in the Catastrophic Benefit Period through Dec. 31, 2026. Part D benefit will reset on Jan. 1, 2027, starting again with a deductible. |
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Source: Centers for Medicare & Medicaid Services (CMS) |
Additional Part D Information
Deductible is annual.
- You pay the plan retail cost for your medications until the deductible is met.
- If your plan has no deductible, initial coverage starts with your first fill.
- Some plans offer at least one drug tier with No Part D Deductible.
Catastrophic max out-of-pocket:
- $2,100 (includes deductible)
- If a drug is not covered, its cost does not count toward any Part D phase totals.
Medicare Prescription Payment Plan:
- Optional. You pay the plan, not the pharmacy.
- Spreads drug costs over the year (does not lower the cost).
