Many seniors have been left wondering about the so-called Medicare “coverage gap”. The “coverage gap” is something which should greatly concern seniors who are enrolled in Medicare Part D. This article will try to help you understand what a Medicare prescription plan’s coverage gap is, why it could be a major problem for some seniors and what is being done to solve it.
Seniors may feel that Medicare prescription plans will cover all of their prescription drug costs. However, this is not the case. Medicare prescription plans will only pay for a senior’s prescription drug costs up to $2,700. After a senior spends $2,700, they have reached what is called the “coverage gap”. For seniors who have enrolled into Medicare prescription plans and have reached the coverage gap, they should realize that the government will no longer cover their prescription drug costs. In summary, the coverage gap means that a senior who has spent $2,700 must pay all of their prescription drug costs completely out of pocket.
Someone who reached the Medicare coverage gap must pay for their prescription drug costs until they have reached the catastrophic coverage level. The catastrophic coverage level is $6,154. A senior who has spent that $6,154 in prescription drugs will have 95% of his/her prescription drug costs covered by Medicare prescription plans.
For example, Sally spent a total of $2,700 in prescription drug costs and now Medicare prescription plans will no longer pay for her prescription drugs because she has reached the coverage gap. If Sally spends an additional $3,454 on Medicare prescription plans then she will be eligible for catastrophic coverage. Catastrophic coverage from Medicare prescription plans will cover 95% of Sally’s prescription drug costs.
The government is concerned about the coverage gap and has enacted legislation under the Patient Protection and Affordable Care Act of 2010 that will close the gap by the year 2020. This should be good news for seniors and their families.