Medicare Part D Prescription Drug Coverage Changes Coming in 2021

  • Date: December 24, 2020

Medicare Part D Prescription Drug Coverage Changes Coming in 2021

A new year comes with new changes including those who are enrolled into Medicare Part D. Here are a few changes we wanted to highlight to keep your apprised.

  • The maximum allowable deductible for standard Part D prescription drug plans will be $445 in 2021, which is up from $435 in 2020.
  • The out-of-pocket threshold (where catastrophic coverage begins) will increase to $6,550 in 2021 (up from $6,350 out-of-pocket in 2020). Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get “catastrophic coverage.” It assures you only pay a small coinsurance amount or copayment for covered drugs for the rest of the year.
  • Medicare beneficiaries with Part D coverage can now access insulin with a copay of $35 a month in 2021. This is expected to save beneficiaries hundred of dollars per year.
  • According to Medicare Resources, the Affordable Care Act has closed the donut hole in Medicare Part D. As of 2020, there is no longer a “hole” for brand-name or generic drugs: Enrollees in standard Part D plans pay 25 percent of the cost (after meeting their deductible) until they reach the catastrophic coverage threshold. Prior to 2010, enrollees paid their deductible, then 25 percent of the costs until they reached the donut hole, then they were responsible for 100 percent of the costs until they reached the catastrophic coverage threshold.

To learn more about how to get prescription drug coverage, what Medicare Part D drug plans cover, the cost for Medicare drug coverage or how Part D works with other insurance, visit the Medicare website.

If you have questions about your long-term care resident’s Medicare Part D prescription medications, please call us at 845 341-2700 or visit our website. Our pharmacists are experts in drug regimen review and would be glad to assist.


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