2021 Medicare Part D Rx prescription plan, also known as Part D helps Medicare members pay for prescription drugs. If you are eligible for Medicare and do not currently have prescription drug coverage, you should consider enrolling in one of these plans.
If you don’t enroll in a drug plan when you’re first eligible and you don’t have other creditable coverage, you may have to pay a “Late enrollment Penalty,” at least 1 percent of your premium for each month you wait to enroll.
Compare Part “D” plans every year:
Medicare Part D Rx plans change every renewal period. The deductible may increase, the companies place drugs on different “Tier” levels, even remove drugs from their formulary list.
2021 Details …
Private insurance companies are the only place to purchase a Part D Rx plan. And most follow a “Standard Benefit Plan Outline” which is as follows:
- Stage 1: Initial deductible ($480) – Not all plans have a deductible. Some plans may have an annual deductible, while others do not have any deductible at all, allowing “first dollar coverage.” After the deductible is met the Plan pays 75% and you pay 25% of covered costs until the total prescription costs meet the initial Coverage Limit of $4,430)
- Stage 2: Initial Coverage Limit ($4,430) – Once you satisfy a deductible, then you will most likely have copays for each of your prescription drugs. This coverage limit extends to the point where the total retail cost of the medication(s) reach $4,430.
- Stage 3: Coverage Gap “Donut Hole” ($4,430 – $7,050) – Next is the “Coverage Gap (Donut Hole) this part of the plan is when you have your retail costs of your prescriptions reach a total of $4,430. Your costs in the Donut Hole are; Brand drugs (25%), and Generic Drugs (25%). These costs you spend will count toward your total out of pocket of $7,050. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plans has set with the pharmacy for that specific drug.
- Stage 4: Catastrophic Coverage ($6,550) – After the Donut Hole, you enter the “Catastrophic Coverage” portion of your plan. This is when the total cost of prescriptions reaches $7,050. At this time, your costs will be, $3.95 copay for generic and $9.85 copay for brand drugs, or 5% coinsurance for the balance of the year.
Enrollment Periods …
- Initial Enrollment Period (IEP) – This period is for people who first become eligible for Medicare Parts A and B coverage. You have 3 months to enroll in a plan once your Part B coverage goes into effect.
- Annual Enrollment Period (AEP) – This is the time each year you are able to change Part D companies or stay with the same plan. The AEP starts each year on October 15 and ends December 7, for an effective date of January 1st.
- Special Enrollment Period (SEP) – Allows a person to enroll in a Part D plan outside the normal enrollment periods. A Special Enrollment period is: when a person looses their current creditable prescription drug coverage with a group health plan. If the Part D company changes benefits of the plan, also if a person moves outside the Part D plan coverage location. These are all examples of a SEP.
- Medicare Advantage Open Enrollment (OEP) – January 1 – March 31. This allows current Medicare Advantage plan members to switch to another company Medicare Advantage plan or, drop your Medicare Advantage and go back to Original Medicare A & B, and enroll in a stand-alone Part D Rx plan.
A good place to start your search …
If you are enrolled in a Medicare Supplement Plan, you will also need to enroll in a separate Medicare part D Rx plan, which will help you pay for your prescription costs. If you are enrolling or enrolled in a Medicare Advantage HMO, you should also see how well that HMO drug plan will cover your medications. A good place to start you search is right here. Call me so we can discuss your best Part D Rx plan options.
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No Cost Help … there is no charge for my services. The insurance companies provide a fee for me to help with coverage options, enrollment and service.