The Medicare Part D Coverage Gap (“Donut Hole”) Made Simple Pt 2

The Medicare Part D Coverage Gap (“Donut Hole”) Made Simple Pt 2

If you and your policy spend $ 3,750 on insured drugs, which include the deductible, in 2018, you have attained the initial coverage threshold and have reached the coverage gap. The initial coverage limit may change annually.

Gap of cover, also known as “period without coverage”: not all will reach this stage; it begins when you and your 2018 policy spend $ 3,750 as described above. In the coverage gap, you will normally pay 35% of the cost of the policy for brand name drugs and 44% of the cost of the Generic Policy in 2018. Once you reach the year, the cost of the prescription drugs will reach $ 5,000 in 2018. Once this amount has been spent, you have reached the catastrophic coverage phase. The cost that you or someone on your behalf (such as your loved one or spouse) is paying for the Part D drugs in your policy formulary or the list of insured drugs will be at your out-of-pocket cost based on the coverage gap.

In addition, manufacturer discounts for brand name drugs count toward reaching the spending limit, which begins with catastrophic coverage. If your policy requires you to buy your prescription drugs at a participating pharmacy, make sure that it is. Otherwise, the costs can not lead to the fact that the coverage gap no longer exists. Keep in mind that the costs that may be charged to you from any other insurance you have, such as prescription drug coverage paid by an employer cannot be accounted for in your expenses.

Catastrophic coverage phase: Once again, not every individual will reach this phase; It starts when your out-of-pocket costs in 2018 gets to $ 5,000. During the catastrophic coverage phase, you pay only a small co insurance or a supplement for the insured prescription drugs for the rest of the year.   The form can change at any time. You can be notified by the Medicare policy.  What costs do you have to exit the gap (“period without coverage”)?

Once you have entered the gap (“uninsured period”), it is important to know what disbursement costs are relevant to achieving catastrophic coverage. Remember, as soon as your spending on prescription drugs gets to $ 5,000 in 2018, you will no longer have this deficit and will have catastrophic coverage for the rest of the calendar year.

The following costs apply to your expenses and the elimination of the gap:

  • Your annual deductible
  • Co payments and co insurance costs that you and your policy spent during the first coverage phase
  • Co payments and co insurance you spend in the coverage gap (in 2018, this represents 35% of the cost of the policy for brand name drugs and 44% of the cost of the generic medication).
  • The manufacturer’s 50% discount for brand name drugs while in the coverage gap

What costs are not excluded from the deficit (“period without coverage”)?  Not all out-of-pocket costs help achieve catastrophic coverage.