What you pay in Catastrophic Coverage depends in your level of Extra Help. If you are qualified for
Medicare Part D Extra Help or the Low-Income Subsidy (LIS), you may have either full or partial LIS benefits - and your cost in the
Catastrophic Coverage phase can vary slightly depending on your level of Extra Help - and this amount can vary year-to-year.
Full Extra Help: $0 in Catastrophic Coverage. If you qualify for full-Extra Help or Low-Income Subsidy (LIS) benefits, you will have a $0 co-pay in the Catastrophic Coverage phase.
Less than full-LIS Benefits: Cost vary year-to-year. If you receive 75% LIS benefits (between 135% and 150% of the Federal Poverty Level (FPL)), you will pay a portion on your drug costs while in Catastrophic Coverage. For example, if you reach
the Catastrophic Coverage phase and you receive 75% LIS benefits, you pay
$4.15 in 2023 for generic / preferred multi-source drugs and
$10.35 in 2023 for all other formulary drugs.
Keep in mind that 2023 is the last year that Medicare Part D beneficiaries will pay cost-sharing in the Catastrophic Coverage phase. For plan year 2024, the
Inflation Reduction Act (IRA) of 2022 eliminates Medicare Part D beneficiary cost-sharing in the Catastrophic Coverage phase.
Also in 2024, the
Inflation Reduction Act (IRA) of 2022 states that benefits for the
low-income subsidy
program will be extended with full-LIS benefit qualifications increased
to 150% of FPL and consequently, the current partial-LIS (135% to 150%
of FPL) designation will be eliminated.
Catastrophic Coverage costs for full- and partial LIS beneficiaries can be found online in our table
Medicare Part D Standard Benefit Model Plan Parameters under the bottom section "Maximum Copayments above
Out-of-Pocket Threshold".