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Medicare Prescription Drug Coverage Information - 2021
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The Medicare prescription drug coverage began on January 1, 2006.
Everyone with Medicare can get this coverage that in most cases will lower
your prescription drug costs and help protect against higher costs in the
future. Medicare Prescription Drug Coverage is insurance. You choose the
drug plan and pay a monthly premium.
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If you have limited income and resources, you may get extra help to cover
prescription drugs for little or no cost. The amount of the monthly premium
is not affected by your health status or how many prescriptions you need.
You will also pay a share of the cost of your prescriptions.
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The decision to get Medicare prescription drug coverage depends on how
you pay for your drugs now and how you get your Medicare coverage.
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The Standard Drug Benefit
The standard benefit is defined in terms of the benefit structure, not the particular drugs
that must be covered. For 2021, the standard benefit includes an initial $445 deductible.
After meeting the deductible the beneficiaries pay 25% of the cost of covered Part D
prescription drugs, up to an initial coverage limit of $4,130 in 2021. Once the initial
coverage limit is reached, beneficiaries are subject to another deductible, known as the
"Donut Hole," or "Coverage Gap," in which they must pay the full costs of drugs. When
the total out-of-pocket expenses on formulary drugs reach $6,550 for 2021 - including the
costs of the deductible and coinsurance - beneficiaries reach the "Catastrophic
Coverage " benefit. Beneficiaries entitled to Catastrophic Coverage pay $3.60 for a
generic or preferred drug and $8.95 for other drugs, or a flat 5% coinsurance, whichever
is greater. This out-of-pocket amount is calculated annually. Beneficiaries who reach the
$6,550 out-of-pocket threshold in one year have to begin to meet it again on January 1st
of the next year.
Because the deductible, initial coverage limit, and annual out-of-pocket threshold change
each year according to the changes in expenditures for Part D drugs, beneficiary out-of
pocket expenses may increase annually.
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Original Medicare only, or Original Medicare and a Medigap
('Supplement') Policy without drug coverage. The new Medicare drug
coverage covers half of the costs for you if you have this kind of coverage
now. Enhanced options are available that provide more coverage.
Original Medicare and a Medigap ('Supplement') Policy with drug
coverage. The new Medicare drug coverage generally provides much more
comprehensive coverage at a lower cost.
Retiree or Union coverage:
In most cases, people with good retiree or union coverage can continue to get
it, with new financial support from Medicare.
Medicare Advantage Plan (like an HMO or PPO) or other Medicare Health
Plan, which already include drug coverage and other extra benefits.
Dual coverage from Medicare with Medicaid drug coverage. These
people automatically got comprehensive prescription drug coverage from
Medicare beginning on January 1, 2006.
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How Much Will the Plans Cost?
When you get Medicare prescription drug coverage, you pay part of the costs, and
Medicare pays part of the costs. You pay a premium each month to join the drug plan.
If you have Medicare Part B, you also pay your monthly Part B premium. If you belong
to a Medicare Advantage Plan or a Medicare Cost Plan, the monthly premium you pay
to the plan may increase if you add prescription drug coverage.
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Your costs will vary depending on which plan you choose and where you live. Your plan
must at a minimum provide you with a standard level of coverage. Some plans offer
more coverage or lower premiums.
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The annual enrollment period for Medicare Part D is November 15 - December 31.
During this period people with Medicare can enroll in a plan or change their enrollment
from one plan to another.
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pagroupinsurance.com offers a service and free information intended to make
access to Medicare and related information easier. It is not associated with, nor
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Financing Administration, the Department of Health and Human Services, or the
Center for Medicare and Medicaid Services, nor do we claim to be. This site
contains basic information about Medicare, services related to Medicare and
services for people with Medicare. If you would like to visit the Official US
Government Site for People with Medicare, go to www.medicare.gov
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Medicare Prescription Drug Coverage Info
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