Prescription Drug Coverage

Getting out of the Gap

Medicare Donut Hole

Medicare beneficiaries who fall into the coverage gap will soon begin to see the light. As part of the Affordable Care Act, people who have prescription drug plans and fall in the donut hole (coverage gap) have a little extra help with paying for prescription drugs.

Incase, you’re still a little foggy on how the donut hole works it goes like this:

1. Enroll in a prescription drug plan. In doing this you usually pay a $310 deductible before Medicare starts kicking in.

2. Enter the initial coverage phase. This phase works like most insurance plans. You pay some and Medicare pays some. The amount you pay is called or coinsurance a copayment and this will vary depending on the drug and plan type.
Prescription drug plans

3. Now say you’re driving on a highway that Medicare has built for you. However, once you have reached the maximum milage designated by Medicare, you are forced take a toll road. This toll road is known as the Donut Hole Expressway and you must pay full price for each toll you incur. After you drive awhile, (horribly dismayed that the Donut Hole Expressway did not in-fact include a single donut-providing establishment along the way,) you see a sign that lets you back on to the open highway.

Metaphor aside, once the amount of coverage received by Medicare reaches $2,840. You enter the donut hole, which means you have to start paying the full cost for your prescription drugs.

If you are in the donut hole long enough for your true out of pocket expenses to reach $4,550, Medicare begins to provide coverage again. This is known as catastrophic coverage.

Starting this year, certain brand name drugs will have a 50% price reduction for Medicare beneficiares in the donut hole phase. Also, if you incurred expenses in the donut hole in 2010, you should receive a $250 rebate check by Medicare. The ultimate goal of the government for prescription drug plans is to entirely phase out this coverage gap by 2010.

To get more information about Medicare Supplement Insurance planstalk to one of our Medigap plan representatives today or use our instant quote below.

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