Expect Changes for Medicare Part D in 2021

Patients will ask important questions about 2021 Medicare Part D plans during open enrollment...Oct 15 to Dec 7.

Many in-person meetings to enroll patients are canceled due to COVID-19. And seniors are hearing about a potential $200 Medicare "drug card" to use for Rxs...but if it comes, it WON'T replace Part D coverage.

Be ready to provide answers to help seniors make a decision.

What's new for 2021? Explain that the maximum annual deductible for most Part D plans will go from $435 to $445. And the coverage gap, or "donut hole," fully closed in 2020...and will stay that way in 2021.

Also expect some Part D plans to cap insulin co-pays at $35/month.

How do I sign up? Keep in mind, pharmacies CANNOT recommend a Part D plan to patients...but you can guide them through the process.

Help seniors navigate to legitimate resources...such as the Medicare.gov website or 800-MEDICARE...to learn about plan options.

Warn about scams...they run rampant around open enrollment.

Educate that Medicare will NOT "cold-call" and ask patients to give personal information to keep coverage...and they WON'T make a "house call" to sign patients up for a Part D plan in person.

How should I pick a plan? Give patients a current med list...so they can add Rxs into the Medicare Plan Finder and estimate cost.

But tell patients not to choose a plan based on premiums alone. Advise also reviewing co-pays, preferred pharmacies, Star Ratings, etc.

What else should I be aware of? Inform patients that their current Part D plan will automatically renew if they do not make a change.

Let people know that there will be a late enrollment penalty if they don't sign up when they're first eligible for Part D.

But eligible patients who have "creditable coverage," such as a drug plan from an employer or union, can usually keep that coverage withOUT paying a penalty if they decide to sign up for Part D later.

Review our technician tutorial, The ABCs of Medicare, for more on 2021 plan changes, help with billing, and a comparison of the different types of Medicare.

Key References

  • www.cms.gov/newsroom/fact-sheets/contract-year-2021-medicare-advantage-and-part-d-final-rule-cms-4190-f1-fact-sheet (10-20-20)
  • www.cms.gov/newsroom/press-releases/trump-administration-continues-keep-out-pocket-drug-costs-low-seniors (10-20-20)
  • www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf (10-20-20)
  • https://innovation.cms.gov/files/x/partd-seniordav-ndclist.pdf (10-20-20)
Pharmacy Technician's Letter. November 2020, No. 361110



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