Here's what you could expect in Medicare Part D costs (2022)

Medicare Part D helps millions of Americans save on prescriptions, but it's not free. Know which Part D costs to expect in 2022.

2022 Medicare Part D costs | Deductibles | Premiums | Drug costs | Other Medicare Part D costs | Is Medicare ever free?

If you are eligible for Medicare, you may be aware that there are several parts to it. Medicare Part A and Medicare Part B (collectively termed Original Medicare) provide health insurance for inpatient hospital stays and outpatient services respectively, among other health services. With Medicare Part C (also called Medicare Advantage) your Part A and Part B (and typically Part D) coverage are administered by a private plan instead of through the federal government. Medicare Part D covers prescription drugs through private plans.

In 2021, nearly 48 million Americans were enrolled in Medicare Part D drug insurance plans, and the Congressional Budget Office estimated that $111 billion will be spent on the program in 2022. Medicare enrollees will contribute about 25% of that amount through Medicare Part D cost sharing—monthly premiums, annual deductibles, copayments, coinsurance, and other out-of-pocket costs—but the remaining 75% is subsidized by the federal government.

Medicare Part D costs 2022

202220212020
Deductible$0-$480$0-$445$0-$435
Premium$33.37 per month on average$31.47 per month on average$30 per on month average
Copay/coinsuranceVaries by drug, plan, and coverage stage.
Initial coverage limit$4,430$4,130$4,020
Coverage gapBeneficiary pays 25% of drug costs until they have spent $7,050 out of pocket for the calendar yearBeneficiary pays 25% of drug costs until they have spent $6,550 out of pocket for the calendar yearBeneficiary pays 25% of drug costs until they have spent $6,350 out of pocket for the calendar year
Late enrollment penalty$33.37$33.06$32.74
Beneficiaries who do not enroll in a Part D plan when they first become eligible, who do not have “creditable coverage,” and are not low income pay 1% of the national base beneficiary premium multiplied by the number of months they’ve been without Part D. The monthly premium is rounded to the nearest $0.10 and added to your monthly Part D premium. This penalty is permanently eliminated for beneficiaries who qualify for Medicaid, Extra Help, or a Medicare Savings Program. Learn more on medicare.gov.

Source: Medicare changes 2022

Deductible: How much do you have to pay out of pocket before Medicare Part D coverage starts?

The cost of your Medicare Part D deductible varies depending on your drug plan. In 2022, the highest deductible price is $480, which is an increase from last year when it was $445. However, not all plans have a deductible.

Premiums: How much does Medicare Part D cost per month?

Part D plans typically have a monthly premium. Since not everyone needs prescription drugs, Medicare prescription drug coverage is optional. The Part D national base beneficiary premium—the amount Part D plans start at—can change from year to year, but in 2022 the average premium is $33.37 per month for each Part D beneficiary. There is also a Part D income-related monthly adjustment amount, or IRMAA, meaning that people with higher incomes may have to pay more according to your 2021 tax return.

2022 Part D income-related monthly adjustment amount

Individual tax returnsJoint tax returnsIncome-related monthly adjustment amount
$91,000 or less$182,000 or lessBeneficiaries just pay their health plan’s premium each month
$91,000-$114,000$182,000-$228,000Pay an additional $12.40 per month
$114,000-$142,000$228,000-$284,000Pay an additional $32.10 per month
$142,000-$170,000$284,000-$340,000Pay an additional $51.70 per month
$170,000-$500,000$340,000-$750,000Pay an additional $71.30 per month
$500,000 or more$750,000 or morePay an additional $77.90 per month
Married but filing separateIncome-related monthly adjustment amount
$91,000 or lessBeneficiaries just pay their health plan’s premium each month
$91,000-$409,000Pay an additional $71.30 per month
$409,000 or morePay an additional $77.90 per month

Source: cms.gov

Copays and coinsurance: How much does Medicare Part D cost per drug?

A copayment, or copay, is a set amount (for instance, $10) that you pay for a prescription each time you get it filled, while your Part D plan pays for the rest. Coinsurance means that you pay a percentage of the cost (for instance, 25%) of the drug each time you fill it while the plan pays the rest. Cost-sharing is set by each plan, and some plans have different copays or coinsurance for generic drugs and brand-name drugs. Each drug is assigned a tier on your plan’s drug formulary. The lower the tier, the cheaper the copay or coinsurance will be. Brand-name drugs are often included in more expensive, higher tiers.

Once you spend $7,050 on covered drugs, you’ll enter the catastrophic coverage stage during which you’ll either pay 5% of the drug cost or $3.70 for generics and $9.20 for brand-name drugs—whichever is greater.

Recently, The Part D Senior Savings Model was introduced under The Centers for Medicare & Medicaid Services (CMS, previously referred to as the Social Security Administration). The program allows participating Medicare prescription drug plans to offer a maximum copayment of $35 per month for insulin. This is a great stride in Part D Medicare coverage as it provides beneficiaries with low prices on life-saving medicine.

RELATED: Does Medicare cover diabetic supplies?

Other Medicare Part D costs

Late enrollment penalties

A less obvious plan cost that some people get stuck with is the late enrollment penalty, which affects anyone who doesn’t opt for a Medicare Part D plan within their seven-month initial open enrollment period but then decides to enroll in Part D later. The penalty, which is a percentage of the Part D national base beneficiary premium, goes up for each month you went without prescription drug coverage, and you will have to pay it for the life of your Part D drug plan—except for the following reasons:

  • You have “creditable” drug coverage, which is a plan that is at least as good as what Medicare offers. Most employer plans and ACA plans will qualify as creditable.
  • You qualify for Extra Help.
  • You have proof that you received bad information about whether your drug coverage before getting Part D was “creditable.”

Here’s an example of a late enrollment penalty:

Fred became eligible for Medicare in 2017, and his initial enrollment period ended on Jan. 1, 2018. Two years later, Fred hasn’t been on creditable drug coverage and decides to enroll in Medicare Part D, and his Part D coverage starts on Jan. 1, 2020. Fred will have to pay a late-enrollment penalty of 24% of the Part D national base beneficiary premium, which is one percentage point for each month. In 2020, that means Fred’s monthly premium would be $32.74 plus $7.86 (24% of $32.74). That number could go up or down each year based on the Part D national base beneficiary premium, but Fred will pay an additional 24% every month he has his drug plan in addition to any IRMAA he might be paying. However, if Fred can qualify for Extra Help, the penalty goes away forever.

Drugs that are not covered by Part D

Another factor that could contribute to prescription drug costs is if you need a medication that isn’t included in your plan’s drug list or formulary. Insurance companies compile a list of drugs related to your condition that they will cover. If you need a drug that isn’t on the list, you could end up paying full price for it. Also, if you are using a drug for off-label use, you could be responsible for the full cost of your drug—even if it’s on your formulary.

Is Medicare Part D ever free?

While a Part D plan might be the most affordable option for many Medicare beneficiaries, it can still be a little expensive.

To help ease the burden on those who need help affording their prescriptions, Medicare Part D includes a low-income subsidy known as Extra Help. For individuals who qualify, Extra Help can reduce plan premiums, deductibles, and copays. It also will eliminate the late enrollment penalty and give people with Medicare a monthly special enrollment period. Under the program, generic drugs should cost no more than $3.95, and brand-name drugs should cost no more than $8.95 in 2022, which will help keep you out of the Medicare Part D donut hole. To see if you qualify for Extra Help, visit ssa.gov.

If you have Original Medicare (Parts A and B), you may be familiar with Medigaps, which are Medicare supplement insurance that helps lower costs of Original Medicare. However, Medigaps do not include prescription drug benefits, so they will not help with the costs of Part D.

You can always use SingleCare to save on your prescriptions, even if you have Medicare. Your price with SingleCare may be more affordable than Medicare if you are in the coverage gap or if your medication isn’t covered by Medicare. For more info on how to use our savings with Medicare, read this article.

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