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Over 1.6 million people enrolled in a 2020 Medicare PDP will see an increase of $20 to $190 in their 2021 initial deductible

Category: Annual Medicare Plan Changes
Published on 2020-10-16 16:57:57


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 deducible 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 deductibles 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 current 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 show the highlight coverage changes for each stand-alone Medicare Part D prescription drug (PDP) and Medicare Advantage (MA or MAPD) plan across the country and include 2020 / 2021 changes in plan features such as premium, deductible, cost-sharing and formulary size changes.  Our compare tools also highlight 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.








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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.