Medicare Part D Costs in 2021

How to Budget Your Prescription Drug Expenses

Before 2006, Medicare did not cover prescription medications, at least not most of them. A limited number of medications were offered under Medicare Part B, but otherwise, you had to pay for your medications out-of-pocket.

That all changed when President George W. Bush passed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in 2003. The law created what we now know of as Medicare Part D, an optional part of Medicare that provides prescription drug coverage.

Part D plans are run by private insurance companies, not the government. However, the federal government sets guidelines on what basic medications these plans must cover and on how much you can be charged. This guide outlines all you need to know about what you will pay for Medicare Part D this year.

pharmacist helping an elderly man
Yuri_Arcurs / E+ / Getty Images

Part D Deductibles

A deductible is the amount of money you spend out-of-pocket before your prescription drug benefits begin. Your plan may or may not have a deductible. The maximum deductible a plan can charge for 2021 is set at $445, an increase of $10 from 2020.

Part D Premiums

A premium is the amount of money you spend every month to have access to a health plan. The government sets no formal restrictions on premium rates and prices may change every year. Plans with extended coverage will cost more than basic-coverage plans.

Part D National Base Beneficiary Premium

Do not confuse the national base beneficiary premium (NBBP) with your monthly premium. Although the rates could technically be the same, they rarely are. The NBBP is a value used to calculate how much you owe in Part D penalties if you sign up late for benefits. Your best bet is to avoid Part D penalties altogether, so be sure to use this handy Medicare calendar to enroll on time. The NBBP is set at $33.06 in 2021, an increase from $32.74 in 2020.

Part D Income-Related Medicare Adjustments Amounts

The government also charges you extra for Part D coverage based on your income. This is known as Income-Related Medicare Adjustments Amounts (IRMAA). You will pay monthly IRMAA to the federal government as well as monthly premiums to the insurance company. In 2018, IRMAA changed the categories of income so that more people would be required to pay a surcharge. In 2019, they added an extra income category. In 2020, they increased the income categories for inflation. If you do not pay your IRMAA in a timely fashion, your Part D plan could be canceled. 

2021 Part D IRMAA for Individuals
Income Category Your 2021 Costs Change from 2020

Less than $88,000
(Less than $87,000 in 2020)

$0 per month

No change

$88,000 - $111,000
($87,000 - $109,000 in 2020)

$12.30 per month

$147.60 per year

$0.10 increase per month

$1.20 increase per year

$111,000 - $138,000
($109,000 - $136,000 in 2020)

$31.80 per month

$381.60 per year

$0.30 increase per month

$3.60 increase per year

$138,000 - $165,000
($136,050 - $163,000 in 2020)

$51.20 per month

$614.40 per year

$0.50 increase per month

$6.00 increase per year

$165,000 - $500,000
($163,000 - $500,000 in 2020)

$70.70 per month

$848.40 per year

$0.70 increase per month

$8.40 increase per year

More than $500,000

$77.10 per month

$925.20 per year

$0.70 increase per month

$8.40 increase per year

2021 Part D IRMAA for Married Couples Filing Jointly
Income Category Your 2021 Costs Change from 2020

Less than $176,000
(Less than $174,000 in 2020)

$0 per month

No change

$176,000 - $222,000
($174,000 - $218,000 in 2020)

$12.30 per month

$147.60 per year

$0.10 increase per month

$1.20 increase per year

$222,000 - $276,000
($218,000 - $272,000 in 2020)

$31.80 per month

$381.60 per year

$0.30 increase per month

$3.60 increase per year

$276,000 - $330,000
($272,000 - $326,000 in 2020)

$51.20 per month

$614.40 per year

$​0.50 increase per month

$6.00 increase per year

$330,000 - $750,000
($326,000 - $750,000 in 2020)

$70.70 per month

$848.40 per year

$0.70 increase per month

$8.40 increase per year

More than $750,000

$77.10 per month

$925.20 per year

$0.70 increase per month

$8.40 increase per year

2021 Part D IRMAA for Married People Filing as Individuals
Income Category

Your 2021

Costs

Change from 2020
Less than $88,000
(Less than $87,000 in 2020)
$0 per month

$0 increase per month

$88,000 - $412,000
($87,000 - $413,000 in 2020)

$70.70 per month

$848.40 per year

$0.70 decrease per month

$10.80 savings per year

More than $412,000
(More than $415,000 in 2020)

$77.10 per month

$925.20 per year

$0.70 decrease per month

$12.00 decrease per year

The Donut Hole

Medicare Part D is far from perfect. In fact, it has a big hole in it. The so-called donut hole is a coverage gap that occurs after you and Medicare have spent a certain amount of money on your prescription medications. After that amount is spent, you are left to pay for your medications on your own until you spend enough to earn "catastrophic coverage" through your Part D plan.

The donut hole closed in 2020 thanks to the Affordable Care Act (aka Obamacare). Starting in 2013, regulations in the Affordable Care Act gradually decreased how much you would be forced to spend out-of-pocket on your medications. Starting in 2020, you will not be allowed to pay more than 25% of the retail costs for your drugs. This is the maximum amount you pay in the initial coverage limit as well.

The amount that you pay for medications before you enter the donut hole, known as the initial coverage limit, is $4,130 for 2021.

Once you are in the donut hole, instead of paying your usual Part D copayment amount, you will pay 25% for all medications. The remaining costs will be paid by the pharmaceutical manufacturer and your Part D plan.

For example, if a brand-name drug costs $100, you will pay $25, the manufacturer $50, and your drug plan $25. For a generic drug, you will pay $25 and your Part D plan will pay $75.

In all Part D plans in 2020, after you've paid $6,550 in out-of-pocket costs for covered medications, you leave the donut hole and reach catastrophic coverage, where you will pay only $3.70 for generic drugs and $9.20 for brand-name medications each month or 5% the cost of those drugs, whichever costs more.

A Word From Verywell

Prescription medications can be costly, but don't let that intimidate you. Know what your Medicare Part D plan covers and how much you can expect to pay. With this information in hand, you can budget for the year ahead and keep any surprises at bay. 

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Article Sources
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