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Medicare Part D Prescription Drug Plans Coverage Changes


Medicare Part D Prescription Drug Plans Coverage Changes in 2021 are available. Many beneficiaries are in the process of figuring out how this will impact them.

Prescription drug expenses can be a drain on the recipient’s monthly income. Drugs that are essential to keeping you healthy and functioning can be costly.

Part D is designed to help alleviate some of the financial challenges beneficiaries face when paying for medication.

What Does Part D Cost in 2021?

The average basic premium for Part D plans saw a decrease in the last year. Lowering drug premiums continues to be a priority for CMS. Part D changes for 2021 address these issues.

Even though there is a trend in rising drug costs, the premium of coverage is going down.

Monthly average Part D costs are $33.06 in 2021. But, for copayments, you’ll need to check the Part D formulary.

Medicare Part D Prescription Drug Plans Coverage Changes for 2021

CMS works hard to make positive changes to the program. They have implemented prohibiting “gag clauses”; so, now pharmacists can tell patients about lower costing ways to obtain medications. Also, CMS requires an Explanation of Benefits to be sent to beneficiaries monthly; this information would include drug prices.

Additionally, CMS has reduced the maximum amount that low-income beneficiaries pay for innovative medications or “biosimilars.” Medicare has increased competition among plans by requiring Part D plans to have a meaningful difference from each other; this makes more plan options for beneficiaries.

The upcoming Annual Enrollment Period for 2021 will begin on October 15th and end on December 7th. During this time, beneficiaries can change Part D policies after comparing drug plan options.

CMS usually releases the information on plans by mid to late September.

Standard Initial Deductible for Part D in 2021

Coverage changes include a slight increase in the initial deductible for prescriptions. The deductible will be $445 in 2021.

The initial deductible goes towards your out of pocket threshold (TrOOP), or when you leave the Donut Hole and move into Catastrophic Coverage.

You pay deductibles before coverage begins. The deductible amount in 2021 is $445, but that doesn’t affect when you enter the Donut Hole portion of the Part D coverage (after expenses of $4,130).

It does impact when you leave the Donut Hole and go to Catastrophic Care coverage.

2021 Medicare Part D Prescription Drug Plans Initial Coverage Limit

The proposed changes to the initial coverage limit in 2021 is said to increase to $4,130. The initial coverage limit sets the donut hole entry point.

You’ll be able to spend a little more on your medications before reaching the donut hole in 2021.

Total Out of Pocket Threshold (TrOOP) for Medicare Part D in 2021

Catastrophic coverage begins after Part D enrollee reaches the TrOOP threshold of $6,550 during one calendar year. The TrOOP is the amount a beneficiary must spend to exit the donut hole and enter into the Part D Catastrophic phase.

Proposed changes to Part D coverage will impact the Donut Hole, otherwise known as the coverage gap. The coverage gap is the amount between when recipients reach their threshold of coverage and when they begin to receive Catastrophic Coverage.

The Donut Hole Brand Name Drug Discount will Increase

For 2021 beneficiaries will only pay 25% of brand name drug costs.

Brand-name drug manufacturers cover 50% of the costs in the coverage gap, the policies include 25% of the costs.

These savings will trickle down to recipients.

Companies making brand-name medications are required to sign agreements to participate in the Coverage Gap Discount Program. Even though there is a discount, the entire cost of the drug will count towards the catastrophic coverage phase.

The Donut Hole Generic Drug Discount will Increase

If you reach the Donut Hole or coverage gap period, the generic drug discount will be 75% in 2021. Your costs for generic drugs while in the donut hole will be 25% of the retail price of the drugs.

For 2021, the plans must pay 75%. Beneficiaries will only pay 25% of the cost.

FAQs

Is the Medicare Donut Hole going away in 2021?
The Affordable Care Act contributes to the lowering of drug costs. In 2021, the donut hole costs are 25% for beneficiaries.
Can I sign up for Medicare Part D at any time?
No, you can only sign up for Part D during an enrollment period.
When can you change Medicare Part D plans?
If you qualify for a Special Enrollment Period, you can change plans now. If not, you may need to wait until the Annual Enrollment Period. Although, if you’re brand new to Medicare, you can enroll during the Initial Enrollment Period.
What is the Medicare Part D deductible for 2021?
The average Part D deductible is $445 in 2021. But, some plans may have different terms.
What are the annual premiums for Part D coverage in 2021?
The average annual premium for Part D coverage is almost $400.

Compare Medicare Part D Plans for 2021

If you’re unsure about drug costs in 2021 and would like an estimate of how much you’ll spend, you can use this Part D plan finder. You can also join our Facebook Community to see what other beneficiaries are doing regarding their Part D drug plans this year.

Also, while Medicare isn’t mandatory, delaying enrollment can result in penalties. Same with Part D, delaying enrollment can result in higher costs.

To get more help give us a call at the number above or fill out an online rate form.

Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

13 thoughts on “Medicare Part D Prescription Drug Plans Coverage Changes

  1. When the prices of the premiums, deductibles, and copays of the drugs increase, then what has been accomplished with these figures and are they in any way accurate when we weigh the increases. Thus far, my calculations have me paying much more in 2020 when I combime the increase in premiums, change of prescription drugs to higher tiers,increase in the drug prices, increase in insurance company premiums. in addition, my MEDIGAP Insurance, Part B, etc increased….. Is this a part of the mullti billion $ medicare cut by our government. Why is the playing field so unequal among the haves and the have nots?

  2. Humana has raised the cost of my plan by more than 100% and added a huge deductible that was not there before. What is this BS about anything going down? We are being lied to again, and cheated. The cost of the least expensive of the plans that I can get to (we don’t have the option of looking at a full list) all cost far more than the one prescription that I take.

    1. Hi Alice! We’ve had a lot of complaints regarding Part D premiums and deductibles going up. We’ve found that if you use the Medicare Plan Finder Tool and input your location & medications, you should be able to find another plan that’s close to what you were paying before.

  3. This once again, is the reason we need free healthcare like other countries. The pharmaceutical and insurance companies are steamrolling over seniors who can’t afford these price increases. Drug costs were to go down! Instead price of premiums have gone up and tier prices have increased! Where is the savings. Another rip off of Seniors.

  4. Humana has announced that they are increasing my premiums by 100% in 2020. Your article says premiums are going down.

    1. Hi Steve! Premiums are going down for some plans and increasing for others, as they do every year. If you use the Medicare Plan Finder Tool, you can search for other Part D plans with other carriers that should hopefully get your premium back down to what it was before. I hope this helps!

  5. I totally understand about the price of Eliquis. It is horrible for something that is supposed to do so much good for you. Unfortunately, it is because there is not yet a generic version for it. I am on a different Part D plan and just found out that my monthly payments will be doubling!! Awful! How can they expect someone on the limited funds of social security to be able to cover that?

  6. Just found out that my Humana drug card payment will go from $29.20 per month to $57.90 per month. I have been getting the 90 day supply in the mail. I take 2 pills per day. In the morning I take Lisinopril 20 mg. In the evening I take sim a statin 20 mg. Tablet. Just checking if there is a cheaper plan out there. Melvin E. Lott

  7. The cost of Eliquis is awful. Just discovered that I am at the top of the donut hole for 2019 At about $150 a month I will no longer be able to take this. So my plan is right now I have one week left this year and I will have to take my chances of having a stroke or heart attack and stop taking it until January.

  8. While CMS is trying to help seniors with Part D RX plans , the deductibles are very high and the pharmaceutical industry is where cost reduction must start, the price of drugs and these ridiculous tiers are not suitable for seniors on a budget.

  9. I cannot afford Victoza because the cost has almost tripled In the donut hole. Paying high insurance copay rates is not right. why do they add what I pay with the amount that the insurance pays to get to the donut hole. Why is the cost so high in the US? I hear other civilized countries has medicine cheaper!

  10. This year the cost of my generic drugs has doubled, or in the case of one drug, quadrupled. When I went to get it refilled, the cost has gone up again! SilverScript did not pay anything towards the cost of these drugs.

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