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What Is A Coverage Gap For Medicare Prescription Plans?

The Coverage Gap in Medicare Prescription Plans is a STAGE of the plan where YOU PAY 100%. Medicare PAYS NOTHING on your drug costs.

If you are eligible for Part A of Medicare, if you’re already enrolled under Medicare Part B, or you have both parts, you qualify for The Part D Prescription Plans. These plans enable you to have Medicare prescription drug coverage through them. There could be a lapse in your coverage at some point. This is called the Coverage Gap and is also referred to as “The Donut Hole”.

How You Can Fall Into The Coverage Gap of Medicare Prescription Plans

Once you have enrolled in one of The Medicare Prescription Plans, Part D, you will have coverage (the amount the plan pays on your prescriptions varies with each plan) up to a specific amount, on your prescription costs. Your plan will have a limit as to how much they will cover in one year’s time. At the point this figure is reached, you fall into the Coverage Gap. You pay all of the costs for all of your prescriptions.

Catastrophic Stage of the Medicare Prescription Plans

Once you have spent a specified amount on your drugs while you are in the Coverage Gap, you will enter into the Catastrophic Stage. This is where you will begin receiving coverage benefits again. You will be entitled to 95% coverage of the costs of your prescriptions until the calendar year ends.

If You Want to Avoid The Coverage Gap in Medicare Prescription Drug Plans See Suggestions Below

Ask your doctor for as many free sample of drugs that he or she can offer.

Suggest to your doctor that you would like to try generic or brand named drugs that are less expensive. This will also reduce your co-pay for your prescriptions with most plans.

You may be eligible for assistance programs. Contact charities or patient organizations to get either low cost drugs or even free drugs, if available.

You may qualify for EXTRA HELP through Medicare if you meet certain criteria related to your income, assets, and savings plans that you may have.



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