What happens when you reach the coverage gap?

Once you reach the coverage limit, you won't pay more than 25% of the cost of brand-name prescription drugs covered by your plan. You'll pay this discounted rate if you buy your prescription drugs at a pharmacy or order them by mail. Some plans may offer you even lower costs during the coverage gap. Most Medicare drug plans have a coverage gap (also called a Medicare “period of no coverage”).

This means that there is a time limit on how much the drug plan will cover for drugs. Not everyone will fall into the coverage gap, and it doesn't apply to members who receive additional help paying for Part D costs. By choosing a Part D plan, the Medicare plan finder can show you when you're likely to enter and exit the period of coverage based on the costs each plan in your area charges for your drugs. You can compare prescription drug plans each year to make sure that your plan offers the best coverage for your drugs.

Check your proof of coverage or call customer service at the number on the back of your Humana identification card to confirm that your plan will cover the service. While Medicare Advantage plans don't cover the coverage gap, an insurer like Anthem might offer coverage for certain drugs that cover that gap. Drug manufacturers pay 70 percent of the insurer's negotiated cost of brand-name drugs to discount what you pay to cover the coverage gap. However, your monthly Part D premiums, any part of the costs your drug plan pays, and what you pay for uncovered drugs won't be counted to help you bridge the coverage gap.

Your Part D plan keeps track of how much you've spent on covered drugs and what stage of coverage you're in. Your Part D plan should keep track of how much money you spent out of pocket on covered drugs and their evolution over the coverage periods, and this information should appear on your monthly statements. The best way to avoid the coverage gap is to try to keep prescription drug costs low, if possible, so as not to reach the initial coverage limit. Part D plans, regulated by the federal government but sold by private insurers, may require you to pay more of the cost of covered drugs once drug costs reach a certain limit.

If you qualify for the Extra Help Part D financial aid program, you won't have any period of coverage. Once you spend a certain amount, you'll break out of the coverage gap and move on to the catastrophic coverage stage. You enter the coverage gap once you and your Medicare Part D plan have paid a certain amount for your prescription drugs in a plan year. The Medicare Part D coverage gap (also known as the coverage gap) is a gap in your Part D prescription drug coverage coverage during which you can pay more for your prescription drugs.

Even though the initial coverage period has closed, you may still see a difference in cost between the initial coverage period and the initial coverage period.

Gertraude Jackel
Gertraude Jackel

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