Medicare Glossary

Definitions for common Medicare terms

catastrophic coverage

DEFINITION: Catastrophic coverage refers to the point when your total prescription drug costs for a calendar year have reached a set maximum level ($5,000 in 2018, and $5,100 in 2019). At this point, you are out of the prescription drug “donut hole” and your prescription drug coverage begins paying for most of your drug expenses.

Once you’ve reached the catastrophic coverage threshold for 2018, you’ll pay at least $3.35 for generic drugs and $8.35 for brand names, or 5 percent of the total drug cost, whichever is higher. The dollar amounts are adjusted for inflation each year; in 2019, if you reach the catastrophic coverage threshold, you’ll pay at least $3.40 for generic drugs and at least $8.50 for brand names.