Frequently Asked Questions about Closing the Coverage Gap

You will receive a 75% discount on all formulary drugs if you reach the Donut Hole or Coverage Gap. As background, starting back in the 2011 Medicare Part D plan year, a discount or co-insurance ( . . .

TrOOP or your total out-of-pocket cost is the total amount you will spend in a year on your formulary drugs before exiting the Coverage Gap (or Donut Hole) and entering the Catastrophic Coverage of yo . . .

Not exactly.  Although we say that the Donut Hole "closed" in 2020 since you receive a 75% discount on all formulary drugs purchased in the Donut Hole, the Coverage Gap still remains as the thi . . .

All generics covered on your Medicare Part D plan's Formulary will receive the Doughnut discount.  The discount on generic drugs purchased in the Coverage Gap applies to all generics covered as f . . .

You will receive the discount directly at the Pharmacy. The Donut Hole discount on medications purchased in the Coverage Gap will be calculated at the point-of-sale (or Pharmacy). However, calculatin . . .

No.  The Donut Hole discount only applies to medications that are included on your Medicare prescription drug plan’s formulary or drug list. If you wish to have your non-formulary medicati . . .

It is possible. The Affordable Care Act limits Medicare Part D coverage for applicable drugs to only those drug manufacturers that have an agreement with the Centers for Medicare and Medicaid Services . . .

The discount on brand-name drugs purchased in the Coverage Gap is broken into two components, 70% is paid by the drug manufacturer and 5% is paid by your Medicare Part D plan. Medicare (that is, th . . .

No.  Only Medicare beneficiaries enrolled in a Medicare Part D prescription drug plan (PDP) or a Medicare Advantage plan that offers a prescription benefit (MA-PD) and who are not enrol . . .

No. The manufacturer discount on brand-name drugs purchased in the Coverage Gap (or Donut Hole) is applied AFTER the plan’s supplemental coverage.In the example of a PACE plan, PACE pays 100% of . . .

No. Even if your Medicare prescription drug plan offers coverage for some generics in the Coverage Gap (for example, you pay a $5 co-pay for all Tier 1 generics), your Medicare Part D plan is not requ . . .

Not exactly.  Although we say that the Donut Hole "closed" in 2020 since you receive a 75% discount on all formulary drugs purchased in the Donut Hole, the Coverage Gap still remains as the thi . . .

You will receive a 75% discount on all formulary drugs if you reach the Donut Hole or Coverage Gap. As background, starting back in the 2011 Medicare Part D plan year, a discount or co-insurance ( . . .

TrOOP or your total out-of-pocket cost is the total amount you will spend in a year on your formulary drugs before exiting the Coverage Gap (or Donut Hole) and entering the Catastrophic Coverage of yo . . .

No.  The Donut Hole discount only applies to medications that are included on your Medicare prescription drug plan’s formulary or drug list. If you wish to have your non-formulary medicati . . .

All generics covered on your Medicare Part D plan's Formulary will receive the Doughnut discount.  The discount on generic drugs purchased in the Coverage Gap applies to all generics covered as f . . .

It is possible. The Affordable Care Act limits Medicare Part D coverage for applicable drugs to only those drug manufacturers that have an agreement with the Centers for Medicare and Medicaid Services . . .

No. Even if your Medicare prescription drug plan offers coverage for some generics in the Coverage Gap (for example, you pay a $5 co-pay for all Tier 1 generics), your Medicare Part D plan is not requ . . .

You will receive the discount directly at the Pharmacy. The Donut Hole discount on medications purchased in the Coverage Gap will be calculated at the point-of-sale (or Pharmacy). However, calculatin . . .

The discount on brand-name drugs purchased in the Coverage Gap is broken into two components, 70% is paid by the drug manufacturer and 5% is paid by your Medicare Part D plan. Medicare (that is, th . . .

No.  Only Medicare beneficiaries enrolled in a Medicare Part D prescription drug plan (PDP) or a Medicare Advantage plan that offers a prescription benefit (MA-PD) and who are not enrol . . .

No. The manufacturer discount on brand-name drugs purchased in the Coverage Gap (or Donut Hole) is applied AFTER the plan’s supplemental coverage.In the example of a PACE plan, PACE pays 100% of . . .