The Medicare coverage gap is the period between coverage limits for Medicare Part D drug coverage. Medicare Part D pays prescription drug costs up to certain point, then stops paying until a higher threshold is reached.
Deductible and Coverage
Plan D is offered by many different insurance companies, and each company sets its own deductible and coverage limits. However, no plan can have a higher deductible than the amount set by Medicare for that year.
The Gap
Once you have reached the out-of-pocket coverage limit in your plan, you enter the "gap" in the plan. Continue using your medical card so your out-of-pocket expenses can be tracked.
Catastrophic Coverage
The plan must begin paying again when you have reached the Medicare-determined threshold for "catastrophic" coverage. This amount is adjusted yearly for inflation.
Generic Drugs
Switching to generic drugs can help keep your out-of-pocket costs low all year. You also can choose to switch to generics when you reach the gap to reduce your costs until catastrophic coverage begins.
Considerations
If your income is below the annual limit set by the government, you may qualify for the Full Extra Help program, which requires no premium or deductible and limits your co-pay amount. There's also a Partial Extra Help program that uses a sliding scale to determine your premium and deductible.
Tags: catastrophic coverage, coverage limits, Extra Help, Extra Help program, have reached, Help program