The Medicare

Why Medicare Part D Coverage Gap May Be Hurting You

The Medicare Part D coverage gap, also known as the donut hole, is a period when Medicare beneficiaries have to pay a higher percentage of their prescription drug costs out-of-pocket. This can be a significant financial burden for many seniors, especially those who take multiple medications.

What is the Medicare Part D Coverage Gap?

The Medicare Part D coverage gap occurs after you have spent a certain amount of money on prescription drugs in a year. In 2023, the coverage gap begins after you and your plan have spent $4,660 on covered drugs. Once you enter the coverage gap, you will pay a higher percentage of the cost of your drugs, typically 25%. This can add up to hundreds or even thousands of dollars per year.

How to Avoid the Coverage Gap

There are a few things you can do to avoid or minimize your time in the coverage gap:

1. Choose a Medicare Part D plan with a low coverage gap. Some Medicare Part D plans have a lower coverage gap than others. When choosing a plan, be sure to compare the coverage gap percentages.
2. Use generic drugs. Generic drugs are just as effective as brand-name drugs, but they cost less. Using generic drugs can help you save money and avoid the coverage gap.
3. Get help from a Medicare Savings Program. If you have low income, you may be eligible for a Medicare Savings Program. These programs can help you pay for your Medicare Part D premiums and deductibles.

What to Do if You Are in the Coverage Gap

If you are in the coverage gap, there are a few things you can do to reduce your costs:

1. Ask your doctor for samples. Many doctors have samples of prescription drugs that they can give to their patients. If you are struggling to afford your medications, ask your doctor if they have any samples available.
2. Look for coupons and discounts. There are a number of websites and organizations that offer coupons and discounts on prescription drugs. You can also ask your pharmacist if they offer any discounts.
3. Talk to your pharmacist about generic drugs. If you are taking a brand-name drug, your pharmacist may be able to help you find a generic equivalent that is less expensive.

If you are a Medicare Part D beneficiary, it is important to understand the coverage gap and how it can affect your costs. By taking the steps to avoid or minimize your time in the coverage gap, you can save money on your prescription drugs. Seeking out help from a licensed agent is another great way to reduce your cost and maximize your plan benefits.