Medicare Part D has helped millions of Medicare patients save on their medication costs.
However, Part D can be confusing — especially when it comes to the Coverage Gap (the
phase of the plan during which you pay 100% of prescription costs). If you joined a standard
Part D plan in 2008, when your total cost for prescription medications reaches $2,510, the
Coverage Gap begins. This applies anytime you purchase a prescription medicine, whether
it is a brand name or generic version.
There is a way to avoid extra spending during the Part D Coverage Gap. By considering
over-the-counter(OTC) alternatives – like Prilosec OTC – you can save your Part D
coverage dollars for more expensive, prescription-only medications.
Total cost = what YOU pay + what Part D pays
How does Part D coverage work?
Although Part D plans vary, they basically work in 3 phases.
Phase 1: You pay a deductible up front, then you pay a "co-pay."
Phase 2: The Coverage Gap — YOU pay all.
Phase 3: Coverage starts again.
Planning ahead is the key to managing the Coverage Gap
The cost of medications can be tough on your budget, but its important to continue taking them.
Here are 3 ways you can manage costs:
Learn More About Planning Ahead to Delay or Avoid The Coverage Gap
Request a Copy of the Medicare Part D Coverage Gap Solutions Brochure
However, Part D can be confusing — especially when it comes to the Coverage Gap (the
phase of the plan during which you pay 100% of prescription costs). If you joined a standard
Part D plan in 2008, when your total cost for prescription medications reaches $2,510, the
Coverage Gap begins. This applies anytime you purchase a prescription medicine, whether
it is a brand name or generic version.
There is a way to avoid extra spending during the Part D Coverage Gap. By considering
over-the-counter(OTC) alternatives – like Prilosec OTC – you can save your Part D
coverage dollars for more expensive, prescription-only medications.
Total cost = what YOU pay + what Part D pays
How does Part D coverage work?
Although Part D plans vary, they basically work in 3 phases.
Phase 1: You pay a deductible up front, then you pay a "co-pay."
- In a standard Part D plan, you pay the full cost of your prescription medications until you have spent $275
(your annual deductible for 2008). After the deductible, coverage
kicks in: - You pay an average co-pay of about 25% of your prescription costs.
- Your Part D plan pays for about 75% of your prescription costs.
- Your Part D plan keeps a running "tab" of whay you pay, plus what the plan pays.
Once this tab reaches $2,510(deductibles + co-pays + Part D), you have used up
your coverage in Phase 1 and hit the Coverage Gap.
*Some plans have no deductible. If you receive extra help with paying your drug costs, you won't have a deductible or Coverage Gap.
Phase 2: The Coverage Gap — YOU pay all.
- Reaching the $2,510 limit triggers the start of the Coverage Gap:
- Part D stops paying for any prescription medications.
- You pay 100% of your prescription costs.
- In the Coverage Gap alone, you spend $3,216 out of pocket.
* Only prescription drugs on your plans list (called a formulary) count toward the $3,216 you spend in the Coverage Gap.
Phase 3: Coverage starts again.
- Once YOU pay $3,216 in the Coverage Gap:
- Your Part D plan starts covering your prescription costs again.
- For the rest of the year, the plan pays 95% of total prescription costs.
- Of course, this phase lasts only until the end of the year. Then the 3-phase cycle
starts all over again.
*Some plans have no deductible. If you receive extra help with paying your drug costs, you wont have a deductible or Coverage Gap.
Planning ahead is the key to managing the Coverage Gap
The cost of medications can be tough on your budget, but its important to continue taking them.
Here are 3 ways you can manage costs:
- 1. Consider generics
- Generic prescription medications can lower your spending, but they still count
toward the Coverage Gap.
- Generic prescription medications can lower your spending, but they still count
- 2. Apply for help if you have limited income
- Call 1-800-Medicare for extra help with Part D.
- Call 1-888-4PPA-NOW or go to www.pparx.org to learn more about patient
assistance programs.
- 3. Consider over-the-counter (OTC) medication alternatives
- OTCs DO NOT count toward the Coverage Gap.
- Consult your doctor and pharmacist to see if OTCs are right for you, and save your
Part D Coverage dollars for more costly prescription-only medications.
Learn More About Planning Ahead to Delay or Avoid The Coverage Gap
Request a Copy of the Medicare Part D Coverage Gap Solutions Brochure
