Medicare Part D Plans in Utah

More Plan Options

The average Utah senior compares three or more plan options before making an enrollment decision.

2021 Medicare Prescription Drug Plan Changes in Utah

Utah seniors, you have more Medicare Part D plan (PDP) choices this year. Also, you'll find 2021 plans with lower monthly premiums, however, the standard initial deductible is now $445 per year, a $10 increase over last year. This increase is offset by a higher Initial Coverage Limit, which increased to $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 Medications

The 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.

Don't make a decision on your choice of Part D Medicare plans based on the premium and deductible alone. It's critical that you verify that your medications are covered. You find this information, and the co-payment tiers, in the formulary. On each PDP page (above) we post links to the formulary and pharmacy web pages, and the phone numbers to contact the plan.

VITAL: Identifying the best Medicare Part D Plans requires research. What works the best for you is all about your regular prescriptions (if any), your health and what you can afford.

Medicare Part D is Included with Most Utah 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 Utah Medicare Advantage Plans that include Part D.

Using Supplement Insurance with Medicare Part D

Thinking about supplemental insurance that can offer you more coverage? It's a smart move. Even with the new health care law, Medicare only covers 80 percent of the hospital and doctor bills incurred by most seniors in the great state of Utah, leaving you to handle the rest. We make it easy to find the lowest price on the Utah Medicare Supplement, commonly called a Medigap plan, you want. The choice is yours, because all Medicare Part D plans are compatible with Utah Medigap plans.

Getting Medicare Part D with Utah Medicaid

If you meet the requirements for both Medicare and Medicaid (aka, dual eligible or Medi-Medi) in Utah, you will automatically receive a Medicare Prescription Drug Plan, as well as Extra Help from Social Security. If you qualify for Extra Help, the program will cover most of the costs of your prescriptions. Even if you qualify, the dual eligible option may not suit your needs. In this case, enroll in the prescription drug plan of your choice. If you receive Medicaid now, call your local Medicaid office for assistance with your dual eligible benefits.

Frequently Asked Questions About Utah Medicare Part D Plans

PDP Eligibility and Availability

You are eligible to enroll in a Utah 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 Salt Lake City, Provo, West Jordan, Orem, Sandy, Ogden, Saint George, Layton, Taylorsville, South Jordan, Logan, and all rural areas of Utah.

Related: Compare 2021 Medicare Part D Plans in Utah

The Medicare Part D information on this page originates from CMS Landscape Source Files, is maintained by David Bynon, and was last updated on December 20, 2020.