If your stand-alone Medicare Part D prescription drug plan (PDP) - or Medicare Advantage plan that
includes drug coverage (MAPD) - has an initial deductible, you will usually pay 100% of your
prescription drug costs until you have met the deductible.
For example, if your Medicare plan has a $445 deductible, you will pay the retail price for your
medications until you have spent $445 and then your plan coverage will begin (and you will only pay
a portion of the retail cost, such as a $30 co-pay or 25% co-insurance on your medications).
Reminder: Low-costing formulary tiers may be excluded from your deductible.
Many 2021 Medicare Part D plans have certain drug tiers excluded from the initial deductible.
For example, you may find that your 2021 Medicare Part D plan has a $445 initial deductible, but
the deductible only applies to medications on formulary Tier 3, Tier 4, and Tier 5 - and your
lower-costing Tier 1 and Tier 2 drugs are covered before meeting the $445 deductible.
About 12 million people will only see a $10 increase in their standard initial deductible.
The 2021 standard Medicare Part D prescription drug plan initial
deductible will increase to $445 from the $435 standard
deductible in 2020 and this $10 increase in deductible could impact about 12,100,000 people currently enrolled in a 2020 stand-alone
Medicare Part D plan -- although many of the plan Members receive "Extra Help" and do not pay the deductible -- and some of these plans
exclude lower-cost generics from the deductible.
Over 1.6 million people will see
an increase in their 2021 initial deductible of $20 or more.
In fact, over 1,000,000 stand-alone Medicare Part D beneficiaries are enrolled in PDP that
will have an initial deductible increase from $30 to $190.
|
Medicare Prescription Drug Plan |
||||||
|
2021 Plan Name |
Deductible |
States |
Members Affected |
|||
2021 |
2020 |
Incr. |
% Incr. | |||
| Prescription Blue Select (PDP) | $445 | $225 | $190 | 75% | MI | 12,048 |
| Anthem Blue Cross MediBlue Rx Standard (PDP) |
$390 | $250 | $140 | 56% |
CA | 47,129 |
| Elixir RxPlus (PDP) was the 2020 EnvisionRxPlus (PDP) | $445 | $335 | $110 | 335% | DC DE MD NY and SC | 70,212 |
| BlueCross Rx Value (PDP) | $300 | $195 | $105 | 54% | SC | 13,463 |
| Anthem MediBlue Rx Standard (PDP) | $430 | $330 | $100 | 30% | CO | 3,115 |
The Good News: About 2.5 million people
will see a decrease in their initial deductible.
As in past years, some stand-alone Medicare Part D plans (PDPs)
have chosen to reduce their initial deductible for the 2021 plan year.
Members of the Blue MedicareRx Essential (PDP) will have a
$180 deductible in 2021 down from $435 in 2020. About 49,800 members of the
Express Scripts Medicare - Choice (PDP) plan will see a
$150 decrease in their deductible.
How to see the changes in your 2021 initial deductible.
Our PDP-Compare
and MA-Compare
tools highlight coverage changes for each stand-alone Medicare Part D prescription drug
(PDP) and Medicare Advantage (MA or MAPD) plan and include 2020 / 2021 changes
in
plan features such as premium, deductible, cost-sharing and formulary
size changes. Our compare tools also show plans that will be merged or
discontinued and plans that will be added in 2021.
Not sure whether you want an initial deductible?
Medicare beneficiaries can telephone Medicare at 1-800-633-4227, speak with a Medicare
representative, and learn more about Medicare plan coverage and their 2021 Medicare Part D and
Medicare Advantage plan options.