What Is the Most Significant Medicare Coverage Gap?

The Medicare Coverage Gap: Is It Really A Problem And Should I Be Worried?”

As a demographic, no group of American citizens is closer to the frontline of rising costs related to today’s medical coverage than the nation’s seniors. When considering the reality of fixed income and dwindling resources, it also becomes apparent that these seniors are some of the most vulnerable to these costs. Concomitantly, the requirement for prescription medication and medical services increases with age. Add the fixed assets to increasing medical costs and Medicare coverage gaps become a problem.

So Where Is The Medicare Coverage Gap?

The intent of Medicare is to provide a multiple layer medical coverage plan. For whatever reason, it is broken down into Plans A, B, C and D. Though there are limitations and problems with all of the plans, the failure of coverage in Plan D is the most wide spread and effects more subscribers by far. Plan D, which covers all prescription drug costs, creates the gap problem.

How Is The Medicare Coverage Gap A Problem?

The Medicare Plan D covers the bulk of prescription drug costs with the insured paying a straightforward reasonable copayment. This continues until the combined payments of the insured and Medicare insurance reach $2,930, at which time Medicare stops payment until a total of $4,700 is paid. This area between $2,930 and $4,700 is the Medicare coverage gap and it results in a $1,770 out of pocket expense to the senior. These gap numbers are not some sort of inflation-adjusted amount, they come from the 2012 Official U.S. Government Medicare Handbook. If a conservative 3.4 million, which, according to a 2008 study from the Kaiser Family Foundation, is the number of people that reached the gap, is used to multiply this $1,770 gap payment, the magnitude of the Medicare coverage gap becomes quite significant.

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