Medicare Part D

Most Prescription Drug Plans, whether they are a stand-alone plan or a part of a Medicare Advantage Plan, have a coverage gap. This coverage gap is often referred to as the Medicare “Donut Hole”. This means there is a temporary limit on what the drug plan will cover for drugs.

Not everyone will enter the coverage gap. If you are on a handful of tier one or generic drugs, you may not need to worry about the Donut Hole. The coverage gap begins after you and your Drug Plan have spent a certain amount for covered drugs. Once you and your plan have spent $4,020 on covered drugs in 2020, you’re in the coverage gap. This amount may change each year. Once you reach the coverage gap, you will pay no more than 25% of the cost for your plan’s covered brand-name prescription drugs. If you receive “Extra Help” with Medicare, which pays for your Part D costs, you won’t enter the coverage gap.

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