Coverage gap, or “donut hole”: After you and your plan have spent a certain amount on covered medications (including the deductible), you may enter the coverage gap, which is a temporary increase in your out-of-pocket prescription drug costs. In the past, beneficiaries paid for all prescription costs once they entered the coverage gap; however, recent health-care legislation created discounts on your costs for covered brand name and generic drugs in the coverage gap. Once you have paid up to a certain amount out of pocket, you’re out of the coverage gap and your Medicare plan begins catastrophic coverage, during which you pay only a small copayment or coinsurance for covered prescription drugs for the rest of the year, while your plan covers the rest of the costs. Health-care reform lowers your costs in the “donut hole” every year until 2020, when the coverage gap is closed.
Medicare Part D Plans and Guide, Prescription Drug Plans
En español l Medicare has an optional program — called Medicare Part D — that provides insurance to help you pay for prescription drugs. If you select to have the coverage, you pay a monthly premium. This guide explains how the program works and helps you make decisions in choosing a plan that’s right for you.
Medicare Part D Costs & Coverage
After you reach your yearly deductible, you may still be responsible for certain out-of-pocket costs, even after your Medicare plan has covered its share. This may include coinsurance and copayments. If you have to pay a coinsurance, you will be responsible for a percentage of the cost of the drug. For example, you may owe a 15% coinsurance each time you fill a particular prescription. If you have to pay a copayment, you will be responsible for paying a set amount for medications on a certain tier as determined by your Medicare plan. As mentioned, Medicare plans that cover prescription drugs place covered drugs into cost tiers, and medications on higher tiers may have higher copayments and coinsurance costs. Your cost sharing may also vary depending on whether you’re taking brand-name or generic medications; generics tend to have lower costs than brand-name prescription drugs.
Prescription Drug Coverage
United American Medicare Part D
As a proud member of the CVS Health family of companies, SilverScript (PDP) shares that commitment by offering affordable, high quality coverage to people with Medicare. Unlike other Medicare insurers, Part D prescription drug coverage is our only business and has been since the Part D program began. We have the experience, expertise and focus to deliver high quality, affordable coverage that millions
Medicare Part D coverage gap
The Medicare Part D coverage gap (informally known as the Medicare donut hole) is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment – consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date are re-set to $0 and continue until the maximum amount of the gap is reached: copayments made by the consumer up to the point of entering the gap are specifically not counted toward payment of the costs accruing while in the gap.