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Center for Medicare and Medicaid Services

2013 Changes for the Defined Standard Medicare Part D Prescription Drug Benefit

  • Initial Deductible: $5 increase to $325 
  • Initial Coverage Limit: $40 increase to $2,970
  • Out-of-Pocket Threshold: $50 increase to $4,750 
  • Coverage Gap (donut hole): begins once you reach your Medicare Part D plan’s initial coverage limit ($2,970) and ends when you spend a total of $4,750.
  • Part D enrollees will continue receive a 52.5% discount on the total cost of their brand-name drugs while in the donut hole. The full retail cost of the drugs will still apply to getting out of the donut hole even though 52.5% was paid for by others. Enrollees will pay a maximum of 79% co-pay on generic drugs while in the coverage gap. 
    Minimum Cost-sharing in the Catastrophic Coverage Portion of the Benefit**: will increase to $2.65 for generic or preferred drug that is a multi-source drug and $6.60 for all other drugs. 
  • Maximum Co-payments below the Out-of-Pocket Threshold for certain Low Income Full Subsidy Eligible Enrollees: will increase to $2.65 for generic or preferred drug that is a multi-source drug and $6.50 for all other drugs.