Is the Medicare donut hole going away in 2021?

Asked by: Miss Savanna Aufderhar DVM  |  Last update: April 7, 2023
Score: 4.3/5 (36 votes)

The Part D coverage gap (or "donut hole") officially closed in 2020, but that doesn't mean people won't pay anything once they pass the Initial Coverage Period spending threshold. See what your clients, the drug plans, and government will pay in each spending phase of Part D.

What happens to the donut hole in 2021?

For 2021, the coverage gap begins when the total amount your plan has paid for your drugs reaches $4,130 (up from $4,020 in 2020). At that point, you're in the doughnut hole, where you'll now receive a 75% discount on both brand-name and generic drugs.

Is the donut hole going away in 2022?

In 2022, the coverage gap ends once you have spent $7,050 in total out-of-pocket drug costs. Once you've reached that amount, you'll pay the greater of $3.95 or 5% coinsurance for generic drugs, and the greater of $9.85 or 5% coinsurance for all other drugs. There is no upper limit in this stage.

Is the donut hole closing?

The donut hole closed for all drugs in 2020, meaning that when you enter the coverage gap you will be responsible for 25% of the cost of your drugs. In the past, you were responsible for a higher percentage of the cost of your drugs.

How long do you stay in the donut hole with Medicare?

When does the Medicare Donut Hole End? The donut hole ends when you reach the catastrophic coverage limit for the year. In 2022, the donut hole will end when you and your plan reach $7,050 out-of-pocket in one calendar year.

The Medicare Donut Hole & The Four Phases

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Is Medicare getting rid of the donut hole?

The Part D coverage gap (or "donut hole") officially closed in 2020, but that doesn't mean people with Medicare won't pay anything once they pass the Initial Coverage Period spending threshold.

How do I get out of Medicare donut hole?

In 2020, person can get out of the Medicare donut hole by meeting their $6,350 out-of-pocket expense requirement.

How much is the donut hole for 2022?

In a nutshell, you enter the donut hole when the total cost of your prescription drugs reaches a predetermined combined cost. In 2022, that cost is $4,430.

Does the Medicare donut hole reset each year?

Your Medicare Part D prescription drug plan coverage starts again each year — and along with your new coverage, your Donut Hole or Coverage Gap begins again each plan year. For example, your 2021 Donut Hole or Coverage Gap ends on December 31, 2021 (at midnight) along with your 2021 Medicare Part D plan coverage.

Does Medigap cover the donut hole?

But Medigap plans don't include any drug coverage at all. Rather, you'll need to get a standalone prescription drug plan and therefore, the donut hole would still apply.

What happens when the donut hole ends in 2020?

Once the year ends, the cycle resets and the costs are adjusted for the new year. The closing of the donut hole simply means everyone will pay a straight 25% of the cost of medications in the Coverage Gap, the same as in Initial Coverage. The biggest difference is how you'll pay that 25%.

Does SilverScript have a donut hole?

With SilverScript, you have access to more than 65,000 pharmacies, as well as many preferred pharmacies. The SilverScript Plus plan has no deductible and more coverage during the Part D donut hole, while the SilverScript Choice and SilverScript SmartRx plans offer lower monthly premiums.

What does Medicare Part D cost in 2022?

The Centers for Medicare & Medicaid Services (CMS) today announced that the average basic monthly premium for standard Medicare Part D coverage is projected to be approximately $33 in 2022.

Will there be a Medicare donut hole in 2022?

In 2022, you'll enter the donut hole when your spending + your plan's spending reaches $4,430. And you leave the donut hole — and enter the catastrophic coverage level — when your spending + manufacturer discounts reach $7,050. Both of these amounts are higher than they were in 2021, and generally increase each year.

What is the max out-of-pocket for Medicare Part D?

The out-of-pocket spending threshold is increasing from $6,550 to $7,050 (equivalent to $10,690 in total drug spending in 2022, up from $10,048 in 2021).

What is the coverage gap amount for 2022?

The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $4,430 on covered drugs in 2022, you're in the coverage gap.

What plans cover the donut hole?

Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole"). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit.

When can Medicare Part D plans be changed?

When Can You Change Part D Plans? You can change from one Part D plan to another during the Medicare open enrollment period, which runs from October 15 to December 7 each year. During this period, you can change plans as many times as you want.

What is the Part D deductible for 2021?

Medicare Part D, also known as prescription drug coverage, is the part of Medicare that helps you pay for prescription drugs. When you enroll in a Part D plan, you are responsible for paying your deductible, premium, copayment, and coinsurance amounts. The maximum Medicare Part D deductible for 2021 is $445.

How much does eliquis cost with Medicare Part D?

On average, the monthly copay for Eliquis with Part D coverage is $37, according to the medication's official manufacturer site. The site also states that roughly half of people taking Eliquis, who also have Medicare coverage, pay $10 or less for the drug each month.

Why is there a donut hole in Medicare Part D?

Why is there a donut hole in Medicare Part D? The donut hole was created to incentivize people to use generic drugs. Thus, keeping beneficiary costs low and reducing Medicare expenses on the program level.

What are the 4 phases of Medicare Part D coverage 2022?

If you have a Part D plan, you move through the CMS coverage stages in this order: deductible (if applicable), initial coverage, coverage gap, and catastrophic coverage.

What is the Part D deductible for 2022?

Most Part D PDP enrollees who remain in the same plan in 2022 will be in a plan with the standard (maximum) $480 deductible and will face much higher cost sharing for brands than for generic drugs, including as much as 50% coinsurance for non-preferred drugs.

How do I get my $144 back from Medicare?

Even though you're paying less for the monthly premium, you don't technically get money back. Instead, you just pay the reduced amount and are saving the amount you'd normally pay. If your premium comes out of your Social Security check, your payment will reflect the lower amount.

Who has the cheapest Part D drug plan?

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Although costs vary by ZIP Code, the average nationwide monthly premium for the SmartRx plan is only $7.08, making it the most affordable Medicare Part D plan this carrier offers.