Medicare makes major Part D change for 2024

Dear Toni: This year, I got into the Medicare “doughnut hole” in July and got out of it in September. I am not sure what I will pay when I leave the doughnut hole. I can see from the Part D monthly statement that my prescription drug costs are exploding.

I’ve tried to research the 2024 Medicare Part D cost online, but it just confuses me. Please give me ideas to help control the doughnut hole cost or not get in it as fast. — Miriam, Tulsa, Oklahoma

Dear Miriam: Your prescription drug problem is a typical doughnut hole problem. Because the cost of brand-name prescriptions is exploding, more Medicare beneficiaries get into the doughnut hole coverage gap quicker. In 2024, Medicare has raised the doughnut hole to $5,030, which can help with this problem. But who knows what prescriptions will cost in the coming year?

Miriam, when you left the doughnut hole in September, you entered what is called catastrophic coverage. For 2023, the cost to you is 5 percent of brand-name or generic drugs, which you will pay for the remainder of this year. For 2024, the new “Medicare &You” handbook explains a major change to Part D catastrophic coverage that will help control the costs of prescriptions for those who enter Part D’s final stage: “Starting January 1, 2024, once your out-of-pocket spending reaches $8,000 … you won’t have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year.”

Here’s the Medicare Part D costs summary for 2024:

■ Initial deductible is $545.

■ Initial coverage limit is $5,030 (after this the doughnut hole begins).

■ The beneficiary will then be responsible for 25 percent of the prescription drug cost, while 70 percent is paid by the brand-name/generic drug manufacturer and 5 percent paid by the enrolled Part D plan. The doughnut hole coverage gap ends when the beneficiary reaches the exit point of $8,000 out of pocket.

■ Catastrophic coverage of $0 out of pocket begins after the $8,000 limit. Medicare will then pick up all prescription costs.

On Jan. 1 of each year, the process starts all over again with a new Medicare prescription drug plan and different costs, deductibles and a new doughnut hole.

Since Oct. 1, when the 2024 Part D plans became available on Medicare.gov, the Toni Says team has seen drastic changes to Part D costs for those with expensive brand-name prescriptions. Here are some tips to help you avoid the doughnut hole or not get in it as quickly:

■ Visit Medicare.gov to view 2024 Part D and Advantage plans. The website has a tool to narrow your search for new plans.

■ Talk to your primary care and specialty doctors about which brand-name drugs can be changed to generics.

■ Get samples from your doctor.

■ Search prescription drug programs such as GoodRx or Single Care for less expensive options. Walmart, Kroger, HEB and Costco also have discount prescription drug plans.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.