The Coverage Gap is Sometimes Referred to as The Donut Hole
Most Medicare drug plans have a coverage gap or donut hole. After you and your health plan have spent a certain amount of money for covered drugs, you have to pay all costs for your drugs during this coverage gap. Which also means that you would then be in the donut hole. You must also continue to pay the monthly premium while you are in the coverage gap.
Each state offers at least one plan with some type of coverage during the coverage gap or donut hole. However, plans with gap coverage may charge a higher monthly premium. Some plans may only offer generic drug coverage during the gap. You can use our free Part D Comparison Tool to see which plans might cover the drugs you use.
Is There Anything I Can Do To Delay Reaching the Coverage Gap?
There are a number of things you can do to help reduce your drug costs, they include:
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Switching to lower cost drugs: Talk to your doctor about using generic and/or over-the-counter (OTC) drugs. Many work as well as the higher cost prescriptions. It can help you save hundreds of dollars a year and can be just enough to keep you out of the coverage gap.
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Take advantage of mail-order programs: They can save you many dollars a year on medication used long term (90 days or longer).
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When you use your Medicare drug plan card at a pharmacy, any money you spend on drugs is automatically counted towards your deductible.
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If you do not have a deductible, or want to delay reaching your coverage gap after meeting your deductible, you may want to utilize a local retail pharmacy who offers a Generic Drug Program. Some pharmacies that offer such a program are: Walmart, Target, Rite Aid, CVS, and Stop & Shop. These programs allow you to purchase 30 day supplies of commonly prescribed generic medications for as low as $4 for a one month supply and as low as $10 for a 90 day supply. Some pharmacy's programs do not require to use your Drug ID card so as a result, this will delay your reacing your coverage gap. (check with each pharmacy to see their rates and conditions. Drug lists are subject to change, please check with pharmcay before purchase. Membership may be required).
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Look for programs that offer assistance: Programs, such as the National Patient Advocate Foundation or the National Organization for Rare Disorders, may have programs that can help with your drug costs. Comprehensive information on federal, state and private assistance programs in your area is available at www.benefitscheckup.org.
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