2021 Standard Part D Benefits Announced by CMS

Medicare Benefits Solutions
Sep 7, 2020

The Centers for Medicare & Medicaid Services (CMS) is the arm of the Department of Health and Human Services (HHS) responsible for administering the Medicare program. To that end, the agency is planning ahead to 2021 and has announced some upcoming changes. 

Medicare Advantage and Part D

Part D falls outside of Original Medicare, and is offered as optional prescription drug coverage to all Medicare recipients. There are two ways to obtain this insurance, and both options require enrollment in Parts A and B. 

The first method is to enroll in a Medicare-approved prescription drug plan (PDP) that serves as an add-on to Original Medicare or some other Medicare-approved plan, such as a Medicare Cost, Private Fee-for-Service or Medical Savings Account plan. The alternative is to sign up for a Medicare Advantage plan that includes drug coverage. A Medicare Advantage plan that includes Part D is known as an MA-PD plan.

Standard Part D Benefits for 2021

Payment changes have been reported in the defined standard benefits for prescription drug plans for 2021. Increases include the deductible from $435 to $445, initial coverage limit from $4,020 to $4,130 and out-of-pocket threshold from $6350 to $6,550.

Catastrophic coverage takes effect when you have reached your out-of-pocket costs for the plan year. At this point, your responsibility is limited to a reduced coinsurance amount or copay for Medicare-covered drugs for the remainder of the year. The minimum cost-sharing amount under catastrophic coverage for 2021 will be $3.70 for generic drugs and $9.20 for brand-name drugs. 

Centers for Medicare & Medicaid Services Proposals

In the current environment of COVID-19, changes in Medicare standards are taking place in 2020 and may indicate what lies ahead for 2021. This disease is serious, especially for certain populations, such as Medicare beneficiaries. The COVID-19 pandemic has propelled a shift in focus toward maximizing the healthcare system’s flexibility to respond as needed.

To remove barriers to critical services, CMS is permitting certain standard requirements to be waived for Part D and Medicare Advantage plans. Both plans may now put the following into effect:

• Forgo cost-sharing payments for COVID-19 tests.
• Abandon cost-sharing payments for COVID-19 treatments in a physician’s practice, ER or telehealth.
• Remove requirements for prior authorization.
• Waive limits on prescription refills.
• Ease up on restrictions imposed on home delivery or mail-order prescriptions.
• Expand access to select telehealth benefits.

Resources for Medicare Benefits and Updates

When searching for more details about Medicare programs, be sure to source the most accurate and up-to-date information. Official government websites include cms.gov and medicare.gov.