Medicare Part D Prescription Drug Plans 2021
Although it is said that the “Doughnut Hole” no longer exists, there are still stages that affect the cost of prescription. Please see the information below. Your plan deductible is also a consideration as to how much you pay out of pocket and the Tier in which your prescription falls.
Initial Coverage Stage
In the Initial Coverage Stage, you (or others on your behalf) will pay a copay or coinsurance each time you fill a prescription, and the plan pays the rest. When your total drug costs—paid by you (or others on your behalf) and the plan—reach $4,130 you then move to the Coverage Gap Stage.
Coverage Gap Stage
During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 25% of the total cost for generic drugs or 25% of the total cost for brand name drugs, for any drug tier until the total amount you (or others on your behalf) and the drug manufacturer have paid reaches $6,550 in year-to-date out-of-pocket costs.
Catastrophic Coverage Stage
You enter the Catastrophic Coverage Stage after $6,550 is reached (excluding premiums), you will have to pay only one of the following through the end of the year: $3.70 copay for generic drugs, $9.20 copay for brand name drugs or a 5% coinsurance, whichever is greater.