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
|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.