PART D 2021
Understanding drug payment stages
During this stage, if your plan has a deductible, you usually pay the full cost of your drugs up to the deductible amount. This generally applies to drugs on Tiers 3, 4 and 5.
Once you reach the deductible amount, you pay a copayment or coinsurance in the initial coverage stage.
Initial Coverage Stage
During this stage, the plan pays its share of the cost and you pay a copayment or coinsurance (your share of the cost) for each prescription you fill until your total drug costs reach $4130.
Once you reach $4130, you enter the coverage gap or “donut hole.”
Coverage Gap Stage
During this stage, you receive limited coverage on certain drugs. You’ll pay 25% of the cost of brand-name drugs (plus part of the dispensing fee) and 25% of the cost of generic drugs. This stage continues until your yearly out-of-pocket drug costs reach $6550.
Once your yearly out-of-pocket costs reach $6550, you move to catastrophic coverage.
Catastrophic Coverage Stage
In this stage, you pay only a small copayment or coinsurance amount for each prescription you fill.