Jack's Blog on Medicare Plan Choices

Understanding the Coverage Gap: A Quick Snapshot

Navigating the world of prescription drug coverage can be confusing, especially when it comes to understanding the coverage gap, often referred to as the “donut hole.” Here’s a concise breakdown to help you understand what counts towards this gap and what doesn’t.

Items that Count Towards the Coverage Gap

• Your yearly deductible, coinsurance, and copayments:
  • These out-of-pocket costs are all factored into the coverage gap calculation.
• The discount you get on brand-name drugs in the coverage gap:
  • Any discounts you receive on brand-name medications while in the coverage gap are included in the total.
• What you pay in the coverage gap:
  • Any amount you pay out-of-pocket while you’re in the coverage gap is also counted.

Items that Don’t Count Towards the Coverage Gap

• The drug plan premium:
  •  Your monthly plan premium is not included in the coverage gap calculation.
• Pharmacy dispensing fee:
  • Fees charged by the pharmacy for dispensing medications are excluded.
• What you pay for drugs that aren’t covered:
  • Any costs for medications not covered by your plan do not count towards the coverage gap.

Understanding these distinctions can help you better manage your prescription drug costs and navigate the coverage gap more effectively. Stay informed and plan ahead to make the most of your benefits.

Before choosing an Advantage or Supplement plan, ensure you have a thorough understanding of Medicare itself. When it’s time to explore your options, don’t fall for a sales pitch from a single company or an agent representing only one provider.

At “More Plans More Choices,” I can provide you with side-by-side comparisons from various insurance carriers. More carriers plus more plans equals more choices.

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Here is my disclaimer.  I gather most of my information from Medicare.gov and to the best of my knowledge, it is accurate.  Please use this information as a guideline and double check it yourself as I am but your humble servant.