About The Medicare Part D Gap for Prescription Drugs

The Medicare insurance gap is the part of Medicare Part D when there is a gap in the prescription drug insurance. You cannot reach this stage at all. It starts when you and your policy spend a certain amount within a year. At this stage, you may have to pay more for your medications until you reach the catastrophic stage. Keep in mind that some policies do not include this insurance gap.

Most Medicare Advantage prescription drug policies and Medicare prescription drug policies have a deficit or “uninsured period.” The insurance gap is achieved when the total of your drug costs (which you and your policy pay) reaches a given amount (i.e. $ 3,750 in 2018). Then, pay a percentage of the cost of the prescription drugs out of pocket until you enter the catastrophic insurance phase of the policy. This is the time when your total out-of-pocket costs, including the annual deductibles and coinsurance, will be $ 5,000 in 2018.

Some Medicare Advantage prescription drug policies and Medicare’s independent prescription drug policies provide partial or full insurance during the insurance gap. For example, some policies may not have a gap, while others may offer insurance of generic drugs in the gap. Policies with gap insurance often charge a higher monthly premium. Therefore, you should only consider one of these policies if you have high drug expenses and look forward to the insurance gap to be reached.

How does the Affordable Care Act affect the insurance gap?

By 2020, when the insurance gap closes, you will gradually pay less for generic and branded drugs.

In 2018, you will pay up to 44% for generic drugs and 35% for brand name drugs.

In 2019, you pay up to 37% for generic drugs and 30% for brand name drugs.

By 2020, you will pay up to 25% for brand name drugs and 25% for generic drugs.

How can I delay in reaching the insurance gap?

There are several ways to reduce the cost of prescription drugs throughout the year and delay the deficit:

Talk to your doctor about the use of cheaper generic drugs that are right for you. Find out if any of your pharmacies are offering your prescription drugs at discounted prices. If you are taking any prescription medication you take regularly, consider the mail-order pharmacy from your Medicare prescription drug policy, if available. This can save you with many policies. If your policy has preferred and non-preferred pharmacies in your network; use a “preferred” pharmacy. Your co payments may be lower if you fill your insured prescriptions at a preferred pharmacy.

Use your policy membership card when you buy your prescriptions. If you use your Prescription Drug Card, you can receive discounts on the drugs you buy and your expenses will be deducted from your deductible.  Look for programs that offer support. You may have government drug assistance programs in your state that can pay for Medicare Part D expenses. Visit Medicare to find out if there is a drug support program for the drugs you are taking.