Medicare Coverage Gap

Medicare Part D Prescription Drug Plans have a coverage gap, which is also known as the “donut hole,” and means there is a temporary limit on what the prescription drug plan will cover for the cost of prescription drugs. The coverage gap is entered once you and your drug plan have paid a combined total of $3,750 (this is the amount for 2018; it changes yearly). You remain in the coverage gap until you reach the yearly out-of-pocket limit, which is $5,000 in 2018. While in the coverage gap, the amount you pay for prescription drugs varies according to whether they are brand name or generic. You won’t pay more than 35 percent of the brand name cost or 44 percent of the generic cost. Find more details here.

Even though Darrin and his plan spent over $3,750 this year on prescription drugs, he was relieved to find out his plan offered a higher savings while he was in the coverage gap.