There are several stages of Part D prescription drug plans. Below is a high-level outline of the various stages of Part D plans:
Stage 1 – Deductible (not all Part D plans have deductibles)
Stage 2 – Initial Coverage
Stage 3 – Coverage Gap also known as the Donut Hole
Stage 4 – Catastrophic Coverage
Once you have spent $6,550 in out-of-pocket costs in 2021, you move out of the donut hole into stage 4 or catastrophic coverage. Once you reach the catastrophic coverage stage of your Part D drug plan, you will only have to pay low coinsurance or copays for covered drugs for the remainder of the year. You will pay either a 5% coinsurance or $3.70 copay for generic medications and $9.20 for brand-name, whichever is lower while in the catastrophic stage. It is important to remember that even if you are in the catastrophic coverage stage, a 5% coinsurance can still amount to significant out of pocket costs if your prescriptions are very expensive.
If you are struggling with your prescription drugs’ cost, there are many programs available to help. These programs include:
- Extra Help, also known as low-income subsidy, helps those with low income get help with prescription costs.
- Some states have State Pharmaceutical Assistance Programs that help pay for prescriptions, Part D premiums, and/or other drug costs.
- Some prescription drug companies offer programs to help pay for medications for those enrolled in Part D plans. Your doctor or insurance company can help you find and enroll in them.
- There are also other national and community-based charitable programs to help with drug costs, including: