The Donut Hole Cost’s Explained

Feb 4, 2021

2021 Medicare Part D Deductible, Costs & Copays. Donut Hole Discount Explained

Medicare Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan.
The 70% paid by the drug manufacturer; the 5% Part D plan discount together with the 25% you pay, count toward your TrOOP (True Out-of-Pocket) or Donut Hole exit point.
Part D changes for 2021 are:

  • Initial Deductible: will be increased by $10 from $435 in 2020 to $445 in 2021.
  • Initial Coverage Limit: will increase by $120 from $4,020 in 2020 to $4130 in 2021 where the 2021 “Donut Hole” begins.
  • Out-of-Pocket  threshold cost: or (TrOOP true out of pocket) will increase from $6,350 in 2020 to $6,550 in 2021.
  • Coverage Gap (Donut Hole): begins once you reach your Medicare Part D plan’s initial coverage limit ($4,130 in 2021) and ends when you spend a total of $6,550 out-of-pocket in 2021.
  • Generic Drug when one reaches Medicare Part D Donut Hole: pay a maximum of 25% co-pay on generic drugs purchased while in the Coverage Gap (receiving a 75% discount).
  • For example: If you reach the 2021 Donut Hole, and your generic medication has a retail cost of $100, you will pay $25. The $25 that you spend will count toward your TrOOP or Donut Hole exit point.
  • Lower costs when one comes out of the Donut Hole and enter Catastrophic coverage until December 31 and then a new year begins. Then the Medicare Part D cycle begins again with a new deductible on January 1 of every year.

Does the Donut Hole really go away? No, the name changed. In 2020, the Donut Hole began being called Donut Hole Discount.
Paul’s Part D Tips      During Medicare’s Annual Enrollment Period from October 15th to December 7th be sure that all your prescriptions are covered by your standalone Medicare Part D plan or a Medicare Advantage plan with prescriptions and if your drugs are expensive make sure you compare options, which will begin January 1st.
Remember you will pay 100% of the cost if any prescriptions (generic or brand name) are not covered on your Medicare Part D plan.
Talk to your doctor or doctors about which brand name drugs can be changed to generics.
Be aware of available prescription assistance programs there are 12 State Pharmaceutical Assistance Programs for people on Medicare depending on what state you live in you may be eligible.
Remember most of us don’t see a doctor every month but we take our prescriptions daily and refill them every month, choosing the right Part D plan can be very important and you should choose wisely.
For help with your Medicare questions or choosing the right part D plan, call us 1-800-219- 0453 0r 631-358-5793  email questions to  medicare@