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Medicare
2022 Benchmark for Medicare Prescription Drug Coverage
(Part D)
Last updated October 2021
Below is the defined standard benefit model as set by Centers for Medicare and Medicaid Services (CMS) for the 2022 plan year. All plans must include these Coverage Stages and provide benefits as good as or better than those shown.
Part D Coverage Levels |
What You Pay |
Coverage Stages |
| Deductible | 100% | $0 to $480 |
| Initial Coverage Period | 25% | After deductible and until total prescription drug costs reach $4,430 |
| Coverage Gap* (Donut Hole) | Brands 75% discount (70% paid by drug company and 5% paid by plan) 25% Paid by member Generics 75% Paid by Plan 25% Paid by member |
Once total yearly drug costs reach $4,430 and until your yearly out-of-pocket drug costs reach $7,050 |
| Catastrophic Coverage | $3.95 for generics under $79 and 5% for those above $9.85 for brand name drugs under $197 and 5% for those above |
Starts after your out-of-pocket drug expenses reach $7,050 and runs through the end of the calendar year. |
*Coverage Gap: In 2022, Part D plan members will receive a 75% discount on the total cost of their covered brand-name drugs purchased while in the donut hole. Of this 75% discount, 70% of it is paid by the brand-name drug manufacturer and will apply towards one’s out of pocket (known as Total or True Out of Pocket or TrOOP) and getting out of the donut hole. The remaining 5% is paid by the Medicare Part D drug plan and will not count toward one’s out of pocket or TrOOP. Also, Medicare Part D enrollees will receive a 75% discount on generic drugs provided by the Part D plan that are purchased while in the donut hole, and the 25% spent by the member will count towards their TrOOP.