Toni Says: 2021 Medicare Part D Deductible and Donut Hole Costs…Released!

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Toni:
This year, the 2021 Medicare and You handbook did not include all the information regarding the Medicare Part D deductibles and “Donut Hole”. I got in the “famous” Medicare donut hole in June of 2020 and do not know how I got there.
I know it is October, but I would like to get prepared and really cannot find the answer online or at the Medicare.gov website. Please inform me what are the 2021 Medicare Part D costs.
I look forward what you have to say. Catherine from Nashville, TN


Catherine:
You are correct that the 2021 Medicare and You handbook did leave some information out regarding the 2021Medicare Part D deductibles or out of pocket maximums.
But guess what?? For the Toni Says® Medicare newspaper column readers, we have a big surprise! I know what the Medicare Part D cost, copays, and Donut Hole out of pocket will be beginning January 1,2021.
2021 Medicare Part D costs and copays are explained below:
Part D changes for 2021 are:
• Initial Deductible: will be increased by $10 from $435 in 2020 to $445 in 2021.
• Initial Coverage Limit: will increase by $120 from $4,020 in 2020 to $4130 in 2021 where the 2021 “Donut Hole” begins.
• Out-of-Pocket threshold cost: or (TrOOP true out of pocket) will increase from $6,350 in 2020 to $6,550 in 2021.
• Coverage Gap (Donut Hole): begins once you reach your Medicare Part D plan’s initial coverage limit ($4,130 in 2021) and ends when you spend a total of $6,550 out-of-pocket in 2021.
• Does the Donut Hole really go away? In 2020, the Donut Hole began being called Donut Hole Discount.
• What is the Donut Hole Discount? Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes, a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan. The 70% paid by the drug manufacturer, 5% Part D plan discount combined with the 25% you pay, count toward your TrOOP or Donut Hole exit point.
• Generic Drug when one reaches Medicare Part D Donut Hole: pay a maximum of 25% co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75% discount).
For example: If you reach the 2021 Donut Hole, and your generic medication has a retail cost of $100, you will pay $25. The $25 that you spend will count toward your TrOOP or Donut Hole exit point.
• Lower costs when one comes out of the Donut Hole and enter Catastrophic coverage until December 31 and then a new year begins. Then the Medicare Part D cycle begins again with a new deductible on January 1 of every year.


Toni’s Tips:
• During Medicare’s Annual Enrollment Period from October 15th to December 7th be sure that all your prescriptions are covered by a new standalone Medicare Part D plan or a Medicare Advantage plan with prescriptions which will begin January 1st.
•  Remember you will pay 100% of the cost if any prescriptions (generic or brand name) are not covered on your Medicare Part D plan.
• Talk to your doctor or doctors about which brand name drugs can be changed to generics.
• Get samples from your doctor.
Do not forget…There is a penalty for not enrolling in a Medicare Part D Prescription Drug plan when you first become eligible to enroll.
Toni King, author of the Medicare Survival Guide® is giving a $5 discount on the Medicare Survival Guide® Advanced book to the Toni Says Medicare column readers at www.tonisays.com.

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