AHIP Medicare Exam Prep 25, Current Part D Benefit Phases and Cost Sharing

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.

In this episode you will learn:

- The current CMS standard Medicare Part D structure features three benefit phases (deductible, initial coverage, catastrophic coverage), completely eliminating the legacy coverage gap or donut hole.

- Maximum standard deductible caps are set by CMS at $590 in 2025 and $615 in 2026, after which beneficiaries pay 25% cost-sharing under defined standard benefit design.

- Beneficiary out-of-pocket spending is capped at the True Out-of-Pocket (TrOOP) threshold of $2,000 in 2025 ($2,100 in 2026).

- Beneficiaries pay $0 cost-sharing in the catastrophic coverage phase, as the former 5% coinsurance requirement has been eliminated.

- TrOOP calculations include beneficiary out-of-pocket costs and manufacturer discounts for covered drugs, but strictly exclude plan premiums and non-formulary drug costs.

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