HOW DOES THE COVERAGE GAP (or more commonly called the “Doughnut Hole”) WORK AND ISN’T SUPPOSED TO CLOSE UP???
Medicare Coverage Gap pdf Version
Medicare Part D, either a standalone Prescription Drug Plan (PDP) or included within an inclusive Medicare Advantage plan, covers your prescription drug costs. You pay for your prescriptions by copays or a percentage of the Medicare-contracted costs. Once you and your Part D insurance carrier have paid out a combined $2,970 for prescription drugs, you enter into the Coverage Gap, or “Doughnut Hole.” During the time you are in the Coverage Gap, your Part D insurance may continue to provide your preferred generic drugs for a copay or at a discounted cost. All of your non-preferred generics and any brand-named prescriptions you may use, will be offered at a discount during the Coverage Gap. Once you reach $4,750 in out-of-pocket costs, your prescription drugs will cost you 5% of the total drug cost for the rest of the year. Your Part D benefits run January 1st to December 31st of each year, as do your regular Medicare benefits.
Over the next several years, you pay less in the coverage gap (Doughnut Hole) until it’s closed by 2020. By 2020, you’ll pay only 25% for covered brand-name and generic drugs during the gap— the same percentage you pay from the time you meet the deductible (if your plan has one) until you reach the out-of-pocket spending limit (up to $4,750 in 2013).
|
You’ll Pay this Percentage for Brand-name Drugs in the Coverage Gap |
You’ll Pay this Percentage for Generic Drugs in the Coverage Gap |
|
|
2013 |
47.5% |
79% |
|
2014 |
47.5% |
72% |
|
2015 |
45% |
65% |
|
2016 |
45% |
58% |
|
2017 |
40% |
51% |
|
2018 |
35% |
44% |
|
2019 |
30% |
37% |
|
2020 |
25% |
25% |
Resources:
http://www.bcbsnc.com/content/medicare
http://www.medicare.gov/Pubs/pdf/11493.pdf
