Medicare Part D Parameters
The 2021 parameters (below) were calculated using the annual percentage increase method, and they will increase by approximately 1.5% to 2.5%, with the out-of-pocket (OOP) threshold increasing by 2% in 2021.
Standard Benefit Parameters
2020 | 2021 | |
Deductible | $435 | $445 |
Initial coverage limit | $4,020 | $4,130 |
Out-of-pocket (OOP) threshold | $6,350 | $6,550 |
Minimum copay (catastrophic portion of benefit) | ||
• Generic/preferred drug | $3.60 | $3.70 |
• All other drugs | $8.95 | $9.20 |
2021 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 combined with the 25% you pay, count toward your TrOOP or Donut Hole exit point.
For example: If you reach the Donut Hole and purchase a brand-name medication with a retail cost of $100, you will pay $25 for the medication, and receive $95 credit toward meeting your 2021 total out-of-pocket spending limit.
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