Until you meet your yearly Part D deductible, you will pay full price for your covered prescriptions. Once the annual deductible is met the plan will begin to cover the cost of your drugs based on the plans prescription drug benefits. While deductibles can vary from plan to plan, no plans deductible can be higher than $445 in 2021, and some plans have no deductible.
In this phase, you will either pay a copay or coinsurance (a percentage of the drug’s cost) when you have a prescription filled. This phase lasts until you and your plan reach a total of $4,130 in 2021 drug spending, at which time you move into the Coverage Gap phase.
This phase is commonly referred to as the "Donut Hole." It occurs after you and your plan reach $4,130 in 2021 in drug spending. During the Coverage Gap phase, you are usually responsible for paying a higher portion of the drug cost. After your true out-of-pocket costs (TrOOP) reach a total of $6,550 in 2021, you move into the Catastrophic Coverage phase. Out-of-pocket costs include your annual deductible as well as your copayments or coinsurance. Premiums do not count towards out-of-pocket costs. Note: Some plans provide additional coverage in the Coverage Gap, which can lower your share of the cost for drugs during this phase.
After you reach a total of $6,550 in 2021 in out-of-pocket prescription drug expenses, you will start paying a different copay or coinsurance for both generic and brand-name prescription drugs. In the Catastrophic Coverage phase, copays are typically lower than during the Initial Coverage phase. This phase lasts until the end of the plan year.