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 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.
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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
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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.
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Justin Lubenow
9/14/2020 11:10:33 am
Hi Jamie,
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Barbara Lobman
9/26/2020 06:35:03 pm
Hello Justin.
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Justin Lubenow
9/28/2020 09:52:31 am
Hi Barbara,
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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
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Justin Lubenow
10/7/2020 04:59:49 pm
Hi Janet,
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Diane (Dina) McWade
10/15/2020 01:04:21 pm
please send RX form to fill out as I do every year with Lubenow
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Justin Lubenow
10/15/2020 04:12:23 pm
Hi Diane - you can submit the Rx form using the link below.
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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.
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Justin Lubenow
9/23/2021 10:09:50 am
Hi Diane,
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Justin Lubenow
9/23/2021 10:10:57 am
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