Last Updated on by
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
Even though there is a trend in rising drug costs, the premium of coverage is going down.
Tip: Medicare Plan D and Part D aren’t the same things.
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.
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.