Bridging the Coverage Gap
If your drug plan has a coverage gap, here are some ways you can avoid or delay entering the gap, and continue to save money on drug costs while in the gap . . .
Download the "Bridging the Coverage Gap" Tips document
Closing the Coverage Gap
In the 2011 Medicare Part D plan year, a discount or co-insurance (cost-sharing) was introduced to reduce the cost of generic and brand-name prescription drugs purchased by non-LIS Medicare beneficiaries once they entered the Coverage Gap (or Donut Hole / Doughnut Hole) portion of their stand-alone Medicare Part D prescription drug plan (PDP) (or Medicare Advantage plan that included prescription drug coverage (MAPD)). Over the years, the Donut Hole discount increased providing more coverage formulary drug purchases in Donut Hole.
Now if you reach the Donut Hole phase of your Medicare prescription drug plan and your medication is on your plan's formulary and you are not receiving financial Extra Help (LIS), you receive a 75% discount on all formulary drugs. (You pay 25% of your plan's negotiated retail cost for any formulary drug purchases made while in the Coverage Gap.)
But isn’t the Coverage Gap (Donut Hole) closed?
Premium Withhold Refund Issue
Please note: If you received a reimbursement of your Medicare Part D premiums and then a letter from the government explaining the mistake and asking that you return the money - you may want to explore your options before returning the reimbursement. The repayment issue is not resolved and you may actually be entitled to keep the refund. For further information, please contact CMS (1-866-292-8080) and ask about your rights and obligations with respect to repaying the erroneous refund. (This topic was highlighted in our September 2006 newsletter.)
In early August, due to a Medicare processing error, roughly 230,000 people received refunds for their drug plan or Medicare Advantage plan premiums in their August 2006 Social Security benefit checks or direct deposits.
People whose plan premiums were mistakenly refunded will not loose any of their Medicare coverage. However, Medicare needs to re-collect the money that was refunded in error.
The document below details the steps that should be taken. It includes the appropriate Medicare telephone numbers and mailing addresses.