Medicare Q & A

Friday, October 12, 2018

Changes to 2019 Medicare Part D

One week to Monday, Oct. 15-Medicare Open Enrollment


I recently received the 2019 Medicare and You handbook did not find any information about what the the 2019 Part D deductibles and “Donut Hole” costs will be. I got in the “famous” Medicare donut hole this March.

I know it is only September, but I would like to get prepared and really cannot find the answer online or at the website. Please inform me what the 2019 Medicare Part D costs will be. I look forward to what you have to say. Karen, Clear Lake, Texas


You are correct that the 2019 Medicare and You handbook did not have the 2019 Part D deductibles or out of pocket maximums. It only says on page 77 that you will pay 25% of some amount for that year when in the Coverage Gap…aka Donut Hole.

But guess what?? For the Toni Says® Medicare newspaper column readers, we have a big surprise! Toni knows what the Medicare Part D costs, copays and Donut Hole will be for 2019.

The 2019 Medicare Part D costs and copays are explained below:

• Initial Deductible:

will be increased by $10 from $405 in 2018 to $415 in 2019.

• Initial Coverage Limit:

will increase by $70 from $3,750 in 2018 to $3,820 in 2019 where the 2019 “Donut Hole” begins.

Out-of-Pocket Cost: will also increase by $100 from $5,000 in 2018 out of pocket to $5,100 in 2019 out of pocket: begins once you reach your Medicare Part D plan’s initial coverage limit ($3,820 in 2019) and ends when you spend a total of $5,100 in 2019. You will spend 25 percent of covered brand name drugs, the drug manufacturer will pay 70 percent and the prescription drug plan will pay the remaining 5 percent of the covered brand name prescription. For generics in the donut hole, you will pay maximum 37 percent co-pay and the prescription drug plan will pay the remaining 63 percent.

• Catastrophic Coverage: Once you have spent the Donut Hole quota for 2019 of $5,100, then you will enter Catastrophic Coverage where your “covered” generic prescription drugs the co pays are $3.40 or 5 percent of the “covered” generic prescriptions above $68 cost or for “covered” brand name prescriptions the co pays are $8.50 or 5 percent of the “covered” brand name prescription drugs above $170 cost.

Toni Says Reader Alert: If your prescriptions are not in your Part D formulary, then YOU WILL pay 100 percent of the prescription drug cost, which is why one must verify that all their prescriptions are in the specific chosen Medicare Part D formulary which can change every year.

Toni’s Tips to help you stay out of the Donut Hole or not get in it as soon:

1) Talk to your doctor or doctors about which brand name drugs can be changed to generics.

2) Use your Medicare Part D plan for your brand name drugs and expensive generics. You do not have to put every prescription on your Medicare Part D plan.

3) Visit for Toni’s 2019 Prescription Drug Survival Guide or visit Course #6 Medicare Prescription Drug Information and learn what your Part D options are.

Facebook Live Event

• “Facebook Live with Toni” about Medicare Part D Tuesday, Oct. 16 at 2 p.m. CST

Toni King the author of Medicare Survival Guide® Advanced, is offering a Medicare Open Enrollment book package special at For questions about Medicare email or call 1-844-250-8664.