Medicare Part D Coverage Gap Made Easy Pt 1
The “donut hole” for Medicare refers to the deficit in your prescription drug: the point at which the cost of prescription drugs exceeds your policy’s initial insurance limit, but has not yet reached the catastrophic level of insurance.
At the launch of Medicare Part D,patients in the uninsured period paid 100% of their drug costs (as opposed to25% before the uninsured period and 5 percent after the uninsured period). TheAffordable Care Act had a provision to close the period without insurance by2020, and the percentage of the cost borne by claimants during the periodwithout insurance has steadily declined since 2011, including the costs ofbrand name drugs and the 44 percent of generic costs. Get a Blue Cross Blue Shield advantage plan to insure good health.
When it comes to Medicare prescription drug insurance, you may have questions about the Medicare Part D insurance gap, also known as the “insurance gap.” The insurance gap is a temporal limit on what many Medicare Advantage Prescription Drug plans or Medicare Part D Prescription Drug Plans pay for the cost of prescription drugs. While you are in the insurance gap, you can pay a higher cost for generic drugs and brand name.
The insurance gap applies to both independent Medicare prescription drug policies and Medicare Advantage prescription drug policies, but not all of them are. If you are currently taking medications or want to reduce the cost of your prescription drugs, it may be helpful to know what the short comings are and how to avoid them.
What is the insurance gap (uninsured hole) and when does it begin?
For those who are not familiar with the insurance gap or the “uninsured period,” knowing the various phases of Medicare Part D insurance is a good place to begin. Your costs and the cost of your Medicare prescription drug policy will vary depending on your insurance period. Normally, each new insurance phase begins as soon as your expenses reach a certain amount. The insurance gap is one of the phases of Medicare Part D insurance.
The Medicare independent prescription drug policies and the Medicare Advantage Prescription Drug Policies can have the following four insurance periods:
Withdrawal – for most MedicareAdvantage Prescription Drug Policies and Medicare Advantage Prescription DrugPolicies, you pay all of the cost of the drug until you reach the annualdeductible amount (if applicable in your policy). Once the deductible has beenmet, the Medicare policy begins to insure the proportion of prescription drugs. The deductible may vary depending on the policy and some policies may not have a deduction. If your Medicare policy does not have a deductible, your coverage will begin in the first phase of insurance.
Primary insurance phase: After reaching the deductible, you will go to the primary insurance phase, where it pays the proportion of the cost of the insured drug policy. For example, if your policy’s performance includes 25% co insurance at this stage and you take a drug that costs $400 per month, your out-of-pocket costs would be approximately $100 per month.