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2021 Medicare Part D Changes

9/9/2020

13 Comments

 
Picture
Each year, there are changes to the Part D Prescription Drug Coverage of Medicare.  We won't have visibility to the actual Part D Plans until October 1, but there are some structural changes that occur each year with Part D.  Key updates for 2021 are below.
  • Annual Deductible Limit - increase of $10 from $435 in 2020 to $445 in 2021
  • Initial Coverage Level increase of $110 from $4,020 in 2020 to $4,130 in 2021
  • True-out-of-Pocket Limit increase of $200 from $6,350 in 2020 to $6,550 in 2021

Annual Deductible
The government sets a maximum deductible amount for the Part D Plans.  In 2020, the maximum deductible was $435.  In 2021, this is increasing $10 to $445.  On most of the Part D Plans, the deductible only applies to higher tiered drugs (e.g. Tiers 3, 4, 5).  Also, some Part D Plans have a $0 deductible, or other amounts lower than the maximum deductible.  

Initial Coverage Level
The Initial Coverage Level will increase $110 from $4,020 in 2020 to $4,130 in 2021. This amount is based on the Retail Cost of the Medication for the year (Calendar Year).  Most people (about 85%) do not exceed the Initial Coverage Level and thus continue to pay their Copay/Coinsurance amount for the entire year.  However, for the people that have very expensive medications that exceed the Initial Coverage Level, they will reach the Part D Coverage Gap, aka Donut Hole where they have to pay 25% the cost of their medications.  The minor increase of $110 to the Initial Coverage level will have a minimal impact on Drug Costs in 2021.  Basically, for those 15% of people with expensive medications, there will be a very slight delay to reaching the Part D Donut Hole which could save someone ~$20-$40 for the year.

True Out of Pocket Limit (Tro-oP)
The True Out of Pocket limit will increase $200 from $6,350 in 2020 to $6,550 in 2021. The Tro-Op is used to determine when someone exits the Part D Coverage Gap, aka Donut Hole, and moves into Catastrophic Coverage where they only have to pay 5% the cost of their medications.  The increase of $200 in the Tro-oP only effects about 5% of people (those that would reach Catastrophic Coverage), and it creates a slight delay for when they will reach Catastrophic coverage.  The net impact to this individual is likely less than $50 cost increase for the year.

​Click the video below for a more detailed explanation of these changes, including a detailed example for someone who reaches the Part D Donut Hole.
13 Comments
Lorraine P Sarhage
9/11/2020 03:33:48 pm

I look forward to working with you again in the coming year. Unfortunately, I have added three new medicines to my drug list so that getting the lowest cost have become even more important.

Reply
Justin Lubenow
9/11/2020 03:55:35 pm

Hi Lorraine - no problem. When you complete the Rx information form, be sure to include all the relevant Rx information and we will include in the analysis. - Justin

https://www.senior-advisors.com/free-rx-analysis.html#rxform

Reply
Jamie Decoskey
9/12/2020 11:59:11 am

My current meds have remained like last year with several exceptions. After having watchman procedure i do not take warfarin but added, clopidagreld and 81 mg chewable asparin.

Reply
Justin Lubenow
9/14/2020 11:10:33 am

Hi Jamie,
If you would like us to complete the 2021 Part D review, please complete the Rx information form.

https://www.senior-advisors.com/free-rx-analysis.html#rxform

Reply
Barbara Lobman
9/26/2020 06:35:03 pm

Hello Justin.
Neither Joe's or my prescriptions have changed since last year.

Reply
Justin Lubenow
9/28/2020 09:52:31 am

Hi Barbara,
If you would like us to complete the 2021 Part D review, please complete the Rx information form.

https://www.senior-advisors.com/free-rx-analysis.html#rxform

Reply
Janet grebe
10/7/2020 11:15:08 am

I was wondering if I should get the more expensive drug plan since I was diagnosed with Rheumatoid arthritis. I don’t know if I will put on a more expensive drug. I am now on Methotrexate my cost is $13.80 per month

Reply
Justin Lubenow
10/7/2020 04:59:49 pm

Hi Janet,

If you would like to review the 2021 Part D Plan, please complete the online Rx form:

https://www.senior-advisors.com/free-rx-analysis.html#rxform

Thx,
Justin

Reply
Diane (Dina) McWade
10/15/2020 01:04:21 pm

please send RX form to fill out as I do every year with Lubenow
Agency In Moorestown NJ
Thank you

Reply
Justin Lubenow
10/15/2020 04:12:23 pm

Hi Diane - you can submit the Rx form using the link below.

https://www.senior-advisors.com/free-rx-analysis.html#rxform

Reply
Diane
9/22/2021 10:07:58 pm

I am in the donut hole. Why is the copay for Ambien, a sleep aid, 82 cents when my insulin copay, which I need to keep me alive, costs $347 for 6 pens, which won’t even last a month. I can’t afford this. I will have to do without until Jan.
I would rather pay some each month than get punched in the stomach in August. The donut hole is cruel.

Reply
Justin Lubenow
9/23/2021 10:09:50 am

Hi Diane,
I am very sorry for what you are experiencing. I agree that Pharmaceutical pricing is completed screwed up in this country, and this is one of the major issues with Healthcare costs in general.

One important point, President Trump initiated an Executive Order in 2019 (called "Senior Savings Model") which reduced the cost of most insulins to $35/month on Part D Plans with no donut hole impact so it stays flat at $35/month for the year. This applies to certain Part D plans and certain types of insulin.

If you would like us to review the Part D costs for 2022, you can click the link below to our Rx form to complete.

Reply
Justin Lubenow
9/23/2021 10:10:57 am

Here are the links:

Senior Savings Model - https://www.senior-advisors.com/medicare-blog/some-good-news-for-diabetics-35-copay

Rx form - https://www.senior-advisors.com/free-rx-analysis.html#rxform




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  • Home
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    • Medicare Supplements & Medicare Advantage >
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      • Medicare Supplement - Plan N >
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  • Medicare FAQs
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