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Medicare Part D

Medicare Part D (drug coverage) can be purchased by private insurance companies.  There are two main ways to get this coverage:

  1.  Separate, stand-alone prescription plan.  This is typically done when you have a Medicare Supplement plan.
  2.  Medicare Advantage - Most Medicare Advantage plans offer the Medicare Part D prescription coverage.  

Medicare Part D Standard Benefit Plan (2021)

Initial Deductible: $445

 

The amount you pay before a plan covers your prescription drug costs.

 

Initial Coverage Limit: $4,130

 

 

 

During this stage, the plan pays its share of the cost
and you pay your share. You are in this stage until
your payments and the plan’s payments total $4,130
for the year.

Coverage Gap (“donut hole”)

 

 

 

When your drug costs and plan payment for the year
reach $4,130 , you enter the Coverage Gap Stage
(donut hole). You will pay 25% of the cost for
formulary brand-name and generic drugs. You will
stay in this stage until your out-of-pocket costs for
the year reach $6,550 .

Catastrophic Coverage

 

 

 

After your out-of-pocket costs for prescription drugs
reach $6,550 , the plan will pay most of your drug
costs for the rest of the year. You will pay either 5%
of the cost of the drug, or a co-pay of $3.70 for
generic drugs or $9.20 for all other drugs.