Coverage Gap
Coverage Gap: What is it and how do I avoid it? If you have Medicare, you may or may not have heard of something called the Donut Hole, known more formally as the coverage gap. But what exactly is it and why do I need to avoid it at all costs? (pun intended) In short, the Donut Hole is a period of time when you will pay a lot more for your medications out of your own pocket. But you’re probably asking yourself, “how did I even get in the Donut Hole in the first place?” Most Medicare plans will pay a maximum amount of $3,700 towards your covered prescription medications. Once they have paid this amount, you will now be considered in the Donut Hole. This usually comes as a shock because most prescription copays up to this point are under $10, but at your next pick-up a copay could be $50 or more, even for generics. So how do you get out of the Donut Hole? As your copays for prescriptions will now be much higher than normal, when your out of pocket expenses reach $4,950, you’ll then be considered outside of the coverage gap, a.k.a [...]
