|
The gap (donut hole) in prescription drug coverage.
Site of Joe Clark Author of
The coverage gap, sometimes called the "donut hole," is the period in which you pay 100% of your drug costs.
Keep in mind that your costs start over at the beginning of each calendar year (January 1st - December 31st).
This gap goes away in 2014 unless Obamacare goes away first.
The gap only applies to other prescription drug coverage.
Most Medicare Beneficiaries will never reach the gap and most of the ones who do will do so late in the year. This is little consolation if you do.
Based on Medicare's minimum standard coverage, the coverage gap will work this way in 2011 (Please be aware that plans vary):
When the total cost (what you and your plan pay) for your drugs reaches $2930, you enter the coverage gap.
You then have to pay 100% of your drug costs (negotiated price, not the full retail price) until you reach $4700 in out-of-pocket costs for the year.
You are eligible, while in the gap, to buy certain name brand drugs at half the retail price while still getting credit for all the retail price toward exiting the gap.
After you have spent $4700 out-of-pocket, you pay 5% of your drug costs (or a small co-payment) for the rest of the calendar year and your plan pays the rest.
This is catastrophic coverage. (co-pay per Rx usually $1/$6)
For more information get the book
|
