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Medicare Prescription Drug Coverage Part D

Filling the Coverage Gap - Donut Hole

Medicare Part D

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Medicare Part D prescription drug coverage, often referred to as Part D, is available from private insurers to anyone who is also eligible for Original Medicare and permanently resides in the service area of a Medicare Prescription Drug Plan. Different insurers offer different types of plans, so your premium and out-of-pocket expenses for prescription drugs will vary.

It can be a good idea to review your Medicare prescription drug coverage every year, to see if the plan you chose covers the medications you need now and may need in the upcoming year.

Typically you pay a monthly premium to be covered under the plan. Also you should be aware of variations in the coverage and cost sharing associated with plans.

Coverage generally follows this pattern:

  1. If the plan has a deductible, you pay the full amount of your prescription drug purchases until the deductible is met.
  2. After you satisfy the deductible, you will pay a share of the costs according to the terms of your plan. Your share, which you typically pay to the pharmacy at the time of pickup, could be a flat amount (copayment) or a percentage of the total amount (coinsurance).
  3. Once you have paid a certain annual maximum amount out of your own pocket for prescription drugs, you automatically get "catastrophic coverage." This means for the rest of that particular year, you would only pay a small copayment or coinsurance amount for prescription drugs.
Be sure to talk to your doctor to see if you are taking the lowest cost medications available to you. Specific coverage may vary from plan to plan, so read your documentation carefully.

Filling the coverage gap

You may have heard of a Medicare coverage gap (also called the "donut hole") but aren't clear what it is. You are not alone! After your Part D coverage has paid a certain amount for prescription drugs, you may have to pay all costs yourself, up to a yearly limit.

The recent federal health care reform legislation will reduce the coverage gap over several years to make prescription drugs more affordable. There will be additional savings in the coverage gap each year through 2020, when the coverage gap is closed completely.

For more information, see "Closing the Coverage Gap" available at www.medicare.gov/Publications/Pubs/pdf/11493.pdf or call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048, 24 hours a day, seven days a week.

Source: ehealthmedicare.com 

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