You may purchase Medicare Part D prescription drug coverage through stand-alone Medicare Prescription Drug Plans (PDPs) or through a Medicare Part C Medicare Advantage plan with prescription drug coverage (MAPDs). These plans have costs, including monthly premiums, annual deductibles, and copays/coinsurance.
PDPs: PDPs are offered by insurance companies that contract with Medicare to provide drug coverage. These plans are a good option for people who get their medical benefits through Original Medicare Parts A and B.
MAPDs: MAPDs are offered by insurance companies that contract with Medicare to provide members with medical benefits and prescription drug benefits (Medicare Part D). You must have Original Medicare Parts A and B to join a Medicare Advantage plan. You cannot have a Medicare Advantage plan and a stand-alone Part D plan at the same time.
Part D drug coverage for 2021
You will move through stages of coverage through the year, based on the cost of your prescription drugs. You may not get to all of the stages in a calendar year.
Deductible stage: You may be responsible for 100% of the cost of covered drugs until you reach the annual deductible (if the plan has a deductible). You will move into the next stage once the deductible is met (maximum $445).
Initial coverage stage: During this stage, the cost of drugs is shared by you and the plan. You will pay copays or coinsurance (approximately 25% of the cost of the medication), and the plan will pick up the remainder.
You will remain in this stage until the retail cost of your drugs reaches $4,130 (this amount is cumulative and includes the retail costs of your drugs through the deductible and initial coverage stages).
Coverage gap (also known as the “donut hole”) stage: Cost-sharing has been decreasing in the coverage gap for several years, and now you pay copays or coinsurance (approximately 25% of the cost of the drug). The remainder is covered by the plan and/or drug manufacturers.
You remain in this stage until your cumulative “true out-of-pocket costs” (including what you and drug manufacturers pay for your drugs) reach $6,550.
Catastrophic coverage stage: If you reach the catastrophic stage, you will pay a small copay or no more than 5% of the cost of your drugs for the rest of the calendar year.
If you are comfortable using the internet, you can investigate your estimated costs for Medicare Part D. Go to www.medicare.gov/plan-compare, where you can enter information about the drugs that you take. The Medicare Plan Finder will show you the lowest-cost plans for you based on the estimated costs of your drugs.