Frequently Asked Questions about Straddle Claims

Jul, 13 2024 — Both.  When you purchase your medications, the retail cost of your drug can move you from one part of your Medicare Part D plan coverage into another part. When this occurs and your prescripti . . .

Sep, 06 2022 — When the cost of your medication covers two parts of your Medicare Part D plan, you have a “straddle claim” where your drug costs are split over two different phases of your drug plan cove . . .

Mar, 14 2024 — Your Medicare Part D drug plan coverage is broken into four parts and you cross between these parts or phases of coverage based on the retail cost of your drugs or your total out-of-pocket spending.&n . . .

Sep, 09 2024 — Yes, you are responsible for the copayment of the formulary drug purchase in the Initial Coverage phase - plus - the cost-sharing on the amount of the purchase price that exceeds your Medicare Part D . . .

Jul, 13 2024 — The Donut Hole Discount applies to the portion of a formulary drug's retail cost that carries over from the Initial Coverage phase and into the Coverage Gap.

Feb, 02 2024 — In most cases, you must pay your Medicare Part D plan's Initial Deductible before you receive Medicare Part D coverage - just as you would with other types of insurance, such as automobile insurance . . .

Jul, 13 2024 — No.  In this situation, you will pay your initial copayment (or cost sharing) for the $1,894 drug plus the difference of the retail amount that takes you into your plan's Donut Hole or Coverage G . . .

Apr, 20 2024 — A portion of the $1,500 retail cost will fall into the Initial Deductible - and the remainder of the cost will fall into the Initial Coverage Phase.  This is called a “straddle claim” . . .