Here are the highlights for the CMS defined Standard Benefit Plan changes from 2015 to 2016
Initial Deductible: will be increased by $40 to $360 in 2016.
Initial Coverage Limit: will increase from $2,960 in 2015 to $3,310 in 2016.
Out-of-Pocket Threshold: will increase from $4,700 in 2015 to $4,850 in 2016.
Coverage Gap (donut hole): begins once you reach your Medicare Part D plan’s initial coverage limit ($3,310 in 2016) and ends when you spend a total of $4,850 in 2016.
In 2016, Part D enrollees will receive a 55% discount on the total cost of their brand-name drugs purchased while in the donut hole. The 50% discount paid by the brand-name drug manufacturer will apply to getting out of the donut hole, however the additional 5% paid by your Medicare Part D plan will not count toward your TrOOP. For example: if you reach the donut hole and purchase a brand-name medication with a retail cost of $100, you will pay $45 for the medication, and receive $95 credit toward meeting your 2016 total out-of-pocket spending limit. Enrollees will pay a maximum of 58% co-pay on generic drugs purchased while in the coverage gap (a 42% discount).
For example: If you reach the 2016 Donut Hole, and your generic medication has a retail cost of $100, you will pay $58. The $58 that you spend will count toward your TrOOP.
Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit: will increase to greater of 5% or $2.95 for generic or preferred drug that is a multi-source drug and the greater of 5% or $7.40 for all other drugs in 2016.
Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees: will increase to $2.95 for generic or preferred drug that is a multi-source drug and $7.40 for all other drugs in 2016.