Part D Coverage Gap, how does it work.
May 7, 2018
By A. F. Kilgore
Most Medicare and prescription drug plans have a coverage gap, also known as the donut hole. Not everyone will enter the donut hole. You enter the donut hole after you and your plan have spent a certain amount,($3750) for covered drugs. During the gap, you have to pay a higher percentage, (44% generic, 35% brand name) of your drug costs.
- Phase 1: Once you've met your deductible, your plan pays a higher percentage of your prescription drug costs until you reach a specified amount. ($3750)
- Phase 2: When you reach that amount, you enter the coverage gap, where you pay a higher percentage of your drug costs. (44% generic & 35% brand while in the gap.)
- Phase 3: When you reach the specified total annual out-of-pocket amount ($5000), you return to paying a lower percentage of your drug costs. This is called Catastrophic coverage, you pay 5% or $3.35 generic and $8.35 for all others drugs. If you have questions contact us: 877-444-6991