TOM MERTON/GETTY IMAGES When first implemented in 2006, Medicare Part D plans had a built-in gap in coverage. During this coverage gap (aka, "Donut Hole") drug plans paid nothing toward the cost of your medications. But that's no longer the case. In 2012, the Affordable Care Act (ACA) implemented a phase-in of discounts for beneficiaries in the Coverage Gap phase of their plan. To demonstrate the rapid change, in 2018, those in the Donut Hole paid 35% of the cost of brand-name drugs and 44% for generics. In 2020, the final year of the phase-in, beneficiaries pay 25% of the cost for any brand-name or generic medication. If you thought that the Coverage Gap was going to be totally eliminated from 2020 Medicare Part D plans, you're not alone. The Coverage Gap phase, which acts as a second deductible, is a design characteristic of the Part D program. MedicareWire found that the key to understanding the Part D Donut Hole going forward is to look at the four phases of Medicare … [Read more...]
What Gaps in Medicare Mean To You
In dictionaries the word gap means a break, a separation, an incompleteness or deficiency. In Medicare it means the same thing, but it refers specifically to something that is missing from your health insurance coverage. Many seniors make a critical mistake when they buy into government literature that explains how Medicare pays for eighty percent of your healthcare. This is not true. What they really mean is Medicare pays for eighty percent of major medical expenses. As a result, millions of Americans are totally unprepared to deal with the true cost of their health and wellness in retirement. Medicare Costs Original Medicare Part A (hospital insurance) and Part B (medical insurance) creates a number of cost gaps. In fact, every deductible, copayment, and coinsurance is a cost gap, because it's a break in your coverage, and you must pay the gap out of your own pocket. One way to fill this gap is with Medigap, also known as Medicare supplement insurance. Medigap is insurance … [Read more...]
What To Do When Your Medicare Drug Plan Doesn’t Cover Your Prescription
Presumably, if you have a Medicare Part D Plan or a Medicare Advantage Plan (Part C) that includes Part D drug coverage, you looked at its formulary before you made the decision to enroll in the plan. Perhaps since then, however, you have developed a need for another medication which is not covered by your health plan. What can you do in this circumstance? You have several options. Consult Your Doctor The first step is to consult your doctor. Your health plan's formulary is the list of drugs it will cover. If your plan does not cover the medication you need, perhaps there is another similar drug in the formulary, which your doctor should know about. In some cases there are other factors involved: The drug you need may require prior authorization. This means that your doctor must notify the plan that for you this drug is medically necessary. Your plan may require step therapy. This means that before your more expensive drug is authorized, you need to try a less-expensive one or … [Read more...]