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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:
- Separate, stand-alone prescription plan. This is typically done when you have a Medicare Supplement plan.
- 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. |