You Need to Know: 2023 Updates for the Medicare Rx Options

Increases to Coverage Gap and Catastrophic Coverage Thresholds

Medicare requires that all Medicare prescription drug plans (including those provided by a Medicare Advantage plan) make certain changes each year. For 2023, the dollar thresholds for certain coverages are increasing:

• The coverage gap dollar threshold increased to $4,660.
• The catastrophic coverage dollar threshold increased to $7,400.

What this means for you:

If you meet the catastrophic coverage threshold, you will then pay:

• Generic drugs: the greater of 5% or $4.15, up to the maximum
• Brand-name drugs: the greater of 5% or $10.35, up to the maximum

Enhanced, Basic, and Value Medicare Rx Options

There are no changes to the copay or coinsurance that you pay for medication in the Initial Coverage stage under the Basic or Value Medicare Rx Options.

2023 updates for the Enhanced and Value Medicare Rx Options are:

• Value Medicare Rx Option: The annual deductible increased to $505.
• Enhanced Medicare Rx Option: The coinsurance for specialty drugs in the Initial Coverage stage reduced to 25%.

Need more info? Refer to the benefit tables for specific copay amounts.