2020 Medicare Prescription Drug Plan Changes in Maine
Maine seniors, you have more Medicare Part D plan (PDP) choices this year. Also, you'll find 2020 plans with lower monthly premiums, however, the standard initial deductible is now $435 per year, a $20 increase over last year. This increase is offset by a higher Initial Coverage Limit, which increased to $4,020.
2020 Medicare Part D Standard Initial Deductible
The initial deductible is the amount that you pay before your Medicare Part D plan begins paying its share of the costs. So, if you enroll in a 2020 prescription drug plan with a standard initial deductible, you'll spend $20 more out-of-pocket in 2020 before coverage begins. Most Medicare Part D plans have an initial deductible, but many popular Medicare Part D plans exclude Tier 1 and Tier 2 drugs from the deductible, giving immediate coverage on most lower-cost medications.
Initial Coverage Limit (ICL)
The 2020 Initial Coverage Limit (ICL) is $4,020, a 5% increase over last year. The Coverage Gap (donut hole) starts when you reach the ICL and ends when you spend a total of $5,100. The Initial Coverage Limit marks the coverage gap entry point. You enter the coverage gap when the total negotiated retail value of your prescription drug purchases exceed your plan’s Initial Coverage Limit.
Will You Fall Into The 2020 Donut Hole?
An easy way to estimate if you will run out of coverage is to look at that average monthly cost of your medications. If your prescriptions have an average retail value of over $335 per month, you will enter the 2020 Donut Hole at some point in the year. This assumes that your current retail drug prices remaining stable.
The 2020 Donut Hole Discount is 75% for Generic Drugs
If you reach the 2020 Coverage Gap phase of your Part D coverage, the generic drug discount will be 75% (up from 63%). This means your generic drug costs in the Donut Hole will be 25% of your Part D plan's negotiated retail prices. What you pay counts towards your true out-of-pocket costs (This amount counts toward your TrOOP).
The 2020 Donut Hole Discount is 75% for Brand-Name MedicationsThe 2020 brand-name Coverage Gap discount remains the same at 75%. The pharmaceutical industry is responsible for picking up 70% of the cost of medications for beneficiaries in the Donut Hole. You get credit for 95% of the retail drug cost toward meeting your 2020 total out-of-pocket maximum or Donut Hole exit point.
Some plans offer additional gap coverage, so look for it on the plan information pages.
How Much Will You Spend To Exit The Donut Hole in 2020?
Your Total Out-of-Pocket Cost (TrOOP) threshold will increase to $6,350 in 2020. That's $1,275 more than the 2019 TrOOP limit of $5,100. TrOOP is the dollar amount you'll spend to get out of the Donut Hole or Coverage Gap and into your Medicare Part D plan's Catastrophic Coverage phase.
It's important to remember that TrOOP doesn't include your monthly premiums or over the counter purchases. Some plans offer additional gap coverage, so look for it on the plan information pages.
Choose from the available Part D Medicare plans carefully, and don't settle on a Part D plan until you know that your most expensive medications are covered at a price you can afford. This information is available in the plan's formulary. You'll find links to the formulary information, pharmacy information, and the customer service phone number on each PDP page (above).
CRITICAL: The best Medicare Part D Plans for you can only be determined by factoring in what you can afford, your regular prescriptions and your health. A bit of time spent on research will pay off in the long run.
Did you Know Most Maine Medicare Advantage Plans Include Prescription Drug Coverage?
Your Medicare benefits are flexible, and there's more than one way to get prescription drug coverage. If you want to keep your Original Medicare, you can enroll in one of the stand-alone Medicare Prescription Drug Plans listed above. The other way to get Part D is by enrolling in one of the Maine Medicare Advantage Plans that include prescription coverage.
Using Supplement Insurance with Medicare Part D
Thinking about supplemental insurance that can offer you more coverage? It's a smart move. Even with the new health care law, Medicare only covers 80 percent of the hospital and doctor bills incurred by most seniors in the great state of Maine, leaving you to handle the rest. We make it easy to find the lowest price on the Maine Medicare Supplement, commonly called a Medigap plan, you want. The choice is yours, because all Medicare Part D plans are compatible with Maine Medigap plans.
Getting Medicare Part D with Maine Medicaid
If you meet the requirements for both Medicare and Medicaid (aka, dual eligible or Medi-Medi) in Maine, you will automatically receive a Medicare Prescription Drug Plan, as well as Extra Help from Social Security. If you qualify for Extra Help, the program will cover most of the costs of your prescriptions. Even if you qualify, the dual eligible option may not suit your needs. In this case, enroll in the prescription drug plan of your choice. If you receive Medicaid now, call your local Medicaid office for assistance with your dual eligible benefits.
Best Maine Medicare Part D Plans
Each year we highlight the Maine PDP's with the lowest cost, most members, and the best ratings. Below are the best 2020 Medicare Part D plans based on these metrics.
Lowest Costs PDP
- The cheapest Maine Part D Plan with no deductible is $32.00
- The cheapest Maine Part D Plan with a deductible ($435.00/year) is $13.20
Most Popular Nation-Wide PDP
- WellCare Classic (0 national members)
- WellCare Value Script (0 national members)
- WellCare Wellness Rx (0 national members)
Most Popular Part D Plans in Maine
- WellCare Classic (0 regional members)
- WellCare Value Script (0 regional members)
- WellCare Wellness Rx (0 regional members)
Most Popular Low-Income Subsidy Medicare Part D Plans
- WellCare Classic (0 national members)
- SilverScript Choice (0 national members)
- Express Scripts Medicare Value (0 national members)
PDP Eligibility and Availability
You are eligible to enroll in a Maine PDP plan if:
- You are a resident of the state,
- You are enrolled in Medicare Part A and Medicare Part B, and
- You are age 65+ or have Medicare due to a qualifying disability.
All plans on this page are available to beneficiaries in Portland, Lewiston, Bangor, South Portland, Auburn, Biddeford, Sanford, and all rural areas of Maine.