UNITED STATES—Toni: This year, the 2021 Medicare and You handbook did not include all the information regarding the Medicare Part D deductibles and “Donut Hole.” I got in the “famous” Medicare donut hole in June of 2020 and do not know how I got there.
I know it is October, but I would like to get prepared and really cannot find the answer online or at the Medicare.gov website. Please inform me what are the 2021 Medicare Part D costs.
I look forward what you have to say. Catherine from Nashville, TN.
Catherine: You are correct that the 2021 Medicare and You handbook did leave some information out regarding the 2021 Medicare Part D deductibles or out of pocket maximums.
But guess what?? For the Toni Says® Medicare newspaper column readers, we have a big surprise! I know what the Medicare Part D cost, copays, and Donut Hole out of pocket will be beginning January 1, 2021.
2021 Medicare Part D costs and copays are explained below:
Part D changes for 2021 are:
-Initial Deductible: will be increased by $10 from $435 in 2020 to $445 in 2021.
-Initial Coverage Limit: will increase by $120 from $4,020 in 2020 to $4130 in 2021 where the 2021 “Donut Hole” begins.
-Out-of-Pocket threshold cost: or (TrOOP true out of pocket) will increase from $6,350 in 2020 to $6,550 in 2021.
-Coverage Gap (Donut Hole): begins once you reach your Medicare Part D plan’s initial coverage limit ($4,130 in 2021) and ends when you spend a total of $6,550 out-of-pocket in 2021.
-Does the Donut Hole really go away? In 2020, the Donut Hole began being called Donut Hole Discount.
-What is the Donut Hole Discount? Part D enrollees will receive a 75 percent Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes, a 70 percent discount paid by the brand-name drug manufacturer and a 5 percent discount paid by your Medicare Part D plan. The 70 percent paid by the drug manufacturer, 5 percent Part D plan discount combined with the 25 percent you pay, count toward your TrOOP or Donut Hole exit point.
-Generic Drug when one reaches Medicare Part D Donut Hole: pay a maximum of 25 percent co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75 percent discount).
For example: If you reach the 2021 Donut Hole, and your generic medication has a retail cost of $100, you will pay $25. The $25 that you spend will count toward your TrOOP or Donut Hole exit point.
-Lower costs when one comes out of the Donut Hole and enter Catastrophic coverage until December 31 and then a new year begins. Then the Medicare Part D cycle begins again with a new deductible on January 1 of every year.
Toni’s Tips:
1) During Medicare’s Annual Enrollment Period from October 15 to December 7 be sure that all your prescriptions are covered by a new standalone Medicare Part D plan or a Medicare Advantage plan with prescriptions which will begin January 1.
2) Remember you will pay 100 percent of the cost if any prescriptions (generic or brand name) are not covered on your Medicare Part D plan.
3) Talk to your doctor or doctors about which brand name drugs can be changed to generics.
4) Get samples from your doctor.
Do not forget…There is a penalty for not enrolling in a Medicare Part D Prescription Drug plan when you first become eligible to enroll.
Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book to the Toni Says Medicare column readers at www.tonisays.com.
