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Q1Medicare Initial Analysis of 2021 PDP Landscape: More low-cost 2021 Medicare Part D PDP options, but many people in 2020 plans may pay higher 2021 Part D premiums

Category: Annual Medicare Plan Changes
Published on 2020-09-28 12:17:17


An initial review of the stand-alone Medicare Part D prescription drug plans (PDPs), recently released by the Centers for Medicare and Medicaid Services (CMS), shows that Medicare beneficiaries will have a few more low-premium 2021 Medicare Part D PDP options but, many current plan members will pay higher 2021 monthly PDP premiums (unless they enroll in a lower-premium 2021 Medicare Part D or Medicare Advantage plan).

Here are more highlights of the 2021 stand-alone Medicare Part D landscape from our PDP-Facts.com analysis:

(1) More 2021 stand-alone Medicare Part D plan options in most states.

The total number of stand-alone 2021 Medicare Part D plans will increase across the country with the average number of 2021 Part D plans per state increasing to 29 plans.

Texas will have the largest gain of PDPs with five (5) additional plan choices and most other states will have one to four (4) additional PDP options. Seven (7) states will have no change and eight (8) states will have one less PDP option in 2021.

You can click here to read more about plan availability and see a chart of how the average number of stand-alone Medicare Part D plans has changed since 2007.

(2) Some 2021 Medicare Part D plans are changing names or carriers.

As in past years, some 2021 stand-alone Medicare Part D plans in your state may be changing their name or even their plan carriers (with changes in cost and coverage).

In fact, our analysis shows that over 2.7 million people currently enrolled in a 2020 plan will find their plan’s name changing in 2021. 

Some examples of plan changes are: the 2020 EnvisionRxSecure PDP will become the 2021 Elixir RxSecure Plan. The 2020 EnvisionRxPlus (PDP) plan will become the 2021 Elixir RxPlus (PDP) in 31 states and the 2021 Elixir RxSecure (PDP) in 23 states.  You can see more Medicare Part D plan changes using our 2020/2021 PDP-Compare tool. Here is an example showing California Part D plan changes: PDP-Compare.com/2021/CA.

(3) The average 2021 stand-alone Medicare Part D premium will increase.

In late-July, CMS forecasted a slight-increase in the Part D combined (PDP & MAPD) average premium, and our analysis of the 2021 stand-alone Medicare Part D plans (PDP-only) supports the CMS forecast. Based on available information, we expect a 1% increase in the average PDP premium from $40.90 in 2020 to $41.38 in 2021.

(4) 67%* of current 2020 Medicare Part D plan members may have increases in 2021 monthly premiums.

When the 2021 Part D premiums are weighted by current 2020 Part D plan enrollment, the weighted average Medicare Part D plan premium will increase 8% to $40.70.

This means, based on 2021 PDP premium increases and current 2020 plan enrollment, around 67%* of all Medicare Part D beneficiaries currently enrolled in a stand-alone 2020 Medicare Part D plan will see an increase in their 2021 monthly premium* -- unless they change coverage to a more affordable 2021 Medicare Part D or Medicare Advantage plan that includes prescription drug coverage (MAPD). You can click here to view a chart of how the average and average weighted Medicare Part D plan premiums have changed since 2007. (* not considering Low-Income Subsidy eligibility)

(5) Slightly more lower-premium 2021 Medicare Part D plan options.

Not only will you see more stand-alone 2021 Medicare Part D plans, our analysis of the 2021 PDP landscape also found a slight increase in the number of PDPs with a premium under $25. For example, Medicare beneficiaries in Ohio will find four (4) additional 2021 Medicare Part D plans with premiums under $25 as compared to 2020.

(6) The lowest and highest premium stand-alone Medicare Part D plans

The Hawaii SilverScript SmartRx (PDP) will have the lowest 2021 Part D premium of $5.70. In all other states, the SilverScript SmartRx (PDP) will have the lowest monthly premium ranging from $6.20 in New Mexico to $7.80 in Oklahoma.

The 2021 Medicare Part D plan with the most expensive premium continues to be the BlueCross Rx Plus (PDP) in South Carolina at $205.30 per month. You can click here to read more about the Medicare Part D plans with the lowest and highest premiums and how the range of premiums has changed since 2007.

(7) More 2021 Medicare Part D plans qualifying for the LIS $0 premium 

There will be slightly more 2021 Medicare Part D plans qualifying for the state’s Low-Income Subsidy (LIS) $0 benchmark premium across the country. 

The states offering the smallest selection of $0 premium LIS PDPs are Florida, Hawaii, Ohio, and South Carolina, with only five $0 premium LIS plans in 2021. Arizona, Illinois, Pennsylvania, and West Virginia will offer the largest number of $0 premium LIS plans (10 plans). You can click here to read more about $0 premium LIS plan availability and see a chart of how the average number of $0 LIS-qualifying Medicare Part D plans has changed since 2007.

(8) Slightly more stand-alone Medicare Part D plans with a $0 initial deductible

As was true in 2020, most 2021 Medicare Part D plans will have an initial deductible ranging from $100 to the 2021 standard initial deductible of $445.  As an example, of the 28 plans available in Florida, only four 2021 stand-alone Medicare Part D plans will have a $0 initial deductible. You can click here to see a chart showing the changes in the total number of Medicare Part D plans offering a $0 deductible since 2007.

(9) Yes, the Donut Hole is “closed”, but you still may pay more for your drugs in the 2021 Donut Hole. 

The 2021 Donut Hole discount remains 75% for all formulary medications -- you pay 25% of retail for both brand-name and generic formulary medications purchased while in the Coverage Gap. Remember, although the Donut Hole closed in 2020, this phase of your Medicare Part D coverage did not go away and you may pay more for your medications if you enter the Donut Hole. You can click here to read more on the 2021 Donut Hole.

(10) Fewer 2021 Medicare Part D plans will offer supplemental Donut Hole coverage.

About 13% of all stand-alone 2021 Part D plans offer some level of additional gap coverage beyond the Donut Hole discount.  For brand-name drug purchases in the Donut Hole, the 70% brand-name drug manufacturer’s Donut Hole discount is applied to this supplemental gap coverage.

(11) About 31% of all 2021 Medicare Part D plans will offer low-cost Insulin coverage.

As part of the new CMS "Part D Senior Savings Model", 31% of all 2021 Medicare prescription drug plans across the country will offer different types of insulin at a maximum co-pay of $35 per month throughout all phases of your drug coverage: deductible, initial coverage, and the Coverage Gap (Donut Hole).  Alabama, Florida, Pennsylvania, Tennessee, and West Virginia will offer 10 plans following the Senior Savings Model and all other states will offer nine (9) plans. These plans show the text “insulin coverage $35 or less” in our PDPFinder.com. You can click here to learn more about low co-pay insulin coverage.



Need an overview of stand-alone Medicare Part D plans in your area?

If you would like to see a specific state’s PDP landscape summary, please use the following links to our interactive 2021 PDP-Facts: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY National Statistics.

Please note: The above information is from our Medicare Part D plan landscape summaries and based on stand-alone Medicare Part D prescription drug plans (or PDPs) – and does not include the U.S. territories.

The 2021 Medicare Advantage plan landscape summary will be presented in our next newsletter. 

A number of 2021 Medicare Advantage plans ( MA/MAPD / MSA / SNP) may be available in your area and may include prescription drug coverage, along with Medicare Part A (hospitalization coverage), Medicare Part B (out-patient and physician coverage), and additional healthcare (and non-health-related) benefits. 

You can use our Medicare Advantage plan finder (MA-Finder.com) for an overview of plans in your area (enter your ZIP to get started).

Copyright Q1Group LLC, Saint Augustine, Florida (2020)






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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.
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  • 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.
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  • 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.
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  • 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.
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  • 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.
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