More Plan Options
The average Montana senior compares three or more plan options before making an enrollment decision.
Montana Medicare Part D 2021 Updates
There are more Montana Medicare Part D Plans (PDPs) in 2021 than in previous years. The bad news is that the standard initial deductible is now $445 per year, an increase of $10 over last year. However, the Initial Coverage Limit increased to a new high of $4,130.
2021 Medicare Part D Standard Initial Deductible
The initial deductible is the amount that you pay before your Medicare Part D plan begins paying its share of the costs. So, if you enroll in a 2021 prescription drug plan with a standard initial deductible, you'll spend $10 more out-of-pocket in 2021 before coverage begins. Most Medicare Part D plans have an initial deductible, but many popular Medicare Part D plans exclude Tier 1 and Tier 2 drugs from the deductible, giving immediate coverage on most lower-cost medications.
2021 Medicare Part D Initial Coverage Limit (ICL)
The 2021 Initial Coverage Limit (ICL) is $4,130. The Coverage Gap (donut hole) starts when you reach the ICL and ends when you hit the out-of-pocket threshold, which is now $6,550. The Initial Coverage Limit marks the coverage gap entry point. You enter the coverage gap when the total negotiated retail value of your prescription drug purchases exceed your plan’s Initial Coverage Limit.
Will You Fall Into The 2021 Donut Hole?
An easy way to estimate if you will run out of coverage is to look at that average monthly cost of your medications. If your prescriptions have an average retail value of over $335 per month, you will enter the 2021 Donut Hole at some point in the year. This assumes that your current retail drug prices remaining stable.
The 2021 Donut Hole Discount is 75% for Generic Drugs
If you reach the 2021 Coverage Gap phase of your Part D coverage, the generic drug discount will be 75%. This means your generic drug costs in the Donut Hole will be 25% of your Part D plan's negotiated retail prices. What you pay counts towards your true out-of-pocket costs (This amount counts toward your TrOOP).
The 2021 Donut Hole Discount is 75% for Brand-Name MedicationsThe 2021 brand-name Coverage Gap discount remains the same at 75%. The pharmaceutical industry is responsible for picking up 70% of the cost of medications for beneficiaries in the Donut Hole. You get credit for 95% of the retail drug cost toward meeting your 2021 total out-of-pocket maximum or Donut Hole exit point.
Some plans offer additional gap coverage, so look for it on the plan information pages.
How Much Will You Spend To Exit The Donut Hole in 2021?
Your Total Out-of-Pocket Cost (TrOOP) threshold will increase to $6,550 in 2021. That's $200 more than the 2020 TrOOP limit of $6,350. TrOOP is the dollar amount you'll spend to get out of the Donut Hole or Coverage Gap and into your Medicare Part D plan's Catastrophic Coverage phase.
It's important to remember that TrOOP doesn't include your monthly premiums or over the counter purchases. Some plans offer additional gap coverage, so look for it on the plan information pages.
Choose from the available Part D Medicare plans carefully, and don't settle on a Part D plan until you know that your most expensive medications are covered at a price you can afford. This information is available in the plan's formulary. You'll find links to the formulary information, pharmacy information, and the customer service phone number on each PDP page (above).
CRITICAL: The best Medicare Part D Plans for you can only be determined by factoring in what you can afford, your regular prescriptions and your health. A bit of time spent on research will pay off in the long run.
Medicare Part D is Included with Most Montana Medicare Advantage Plans
There's more than one way to get prescription drug coverage with your Medicare benefits. The first way is by enrolling in one of the Medicare Prescription Drug Plans listed above. The second way to get help paying for your prescriptions is through one of the Montana Medicare Advantage Plans that include Part D.
Medicare Part D and Supplements Work Together
Medicare does not pay for all of your hospitalization and doctor bills. Even with the new healthcare law fully in place, your Original Medicare only pays about 80 percent of your Montana healthcare bills. We keep an up-to-date catalog of Montana Medigap Plans, also call a Medicare Supplement, with the tools you need to find the best price and coverage. The Medicare PartD plans above are fully compatible with Montana supplemental insurance.
Montana Medicaid and Your Medicare Part D
Montana seniors who qualify for both Medicare and Medicaid (aka, dual eligible or Medi-Medi) may be enrolled in a Montana Medicare Prescription Drug Plan automatically, as well as Social Security's Extra Help program. The Extra Help program pays for most of your prescriptions, but only if you meet the strict eligibility requirements. If the dual eligible option does not meet your needs, you have the option to enroll in a Montana Part D plan that does. If you are already receiving Medicaid, contact your local Medicaid office for assistance in the transition to Medicare.
Frequently Asked Questions About Montana Medicare Part D Plans
What is best for you may not be best for someone else. It all has to do with where you live and your regular prescriptions. These are some of the top plans in 2021:
For the 2021 plan year, the average cost of a prescription drug plan (Part D) is around $32, but that varies a little by location. Basic plans start around $20. To see all of your options in Montana, check out this page.
All Montana Medicare Part D plans, including premium, deductible, and copay information is available on this page. You will also find the 5-star rating that CMS has given each plan.
PDP Eligibility and Availability
You are eligible to enroll in a Montana PDP plan if:
- You are a resident of the state,
- You are enrolled in Medicare Part A and Medicare Part B, and
- You are age 65+ or have Medicare due to a qualifying disability.
All plans on this page are available to beneficiaries in Billings, Missoula, Great Falls, Bozeman, Butte, Helena, and all rural areas of Montana.