Part D Coverage Gap, how does it work.

May 7, 2018

By A. F. Kilgore

Most Medicare and prescription drug plans have a coverage gap, also known as the donut hole.  Not everyone will enter the donut hole.  You enter the donut hole after you and your plan have spent a certain amount,($3750) for covered drugs.  During the gap, you have to pay a higher percentage, (44% generic, 35% brand name) of your drug costs.

  •  Phase 1: Once you've met your deductible, your plan pays a higher percentage of your prescription drug costs until you reach a specified amount. ($3750)
  •  Phase 2: When you reach that amount, you enter the coverage gap, where you pay a higher percentage of your drug costs.  (44% generic & 35% brand while in the gap.)
  • Phase 3: When you reach the specified total annual out-of-pocket amount ($5000), you return to paying a lower percentage of your drug costs.  This is called Catastrophic coverage, you pay 5% or $3.35 generic and $8.35 for all others drugs.  If you have questions contact us:  877-444-6991