Medicare Part D - Closing the Coverage Gap

The Medicare Part D Coverage Gap (also known as the Donut Hole) closed in 2020. Plan members of a Part D or (a Medicare Advantage Plan that includes drug coverage) will only pay 25% coinsurance of Brand-name and Generic drugs while in the coverage gap. 

The coverage gap closed by keeping the manufacturers 50% discount and increasing what Medicare drug plans cover. The coverage gap had been gradually shrinking for several years since the Affordable Care Act set a path to close it by 2020. However the gap really was never scheduled to close 100%. This still doesn’t mean you will get your medications for free, plan members will still pay 25% out of their pockets while in the coverage gap stage. However if your total prescription drug costs exceeds a certain dollar amount (which the amount can and usually does change each year), then your total out of pocket prescription drugs costs goes back down to a specified level during what is called the “Catastrophic" coverage stage.

Click on link for a related blog post of what is the coverage Gap (also known as the Donut Hole): Medicare Part D - The Doughnut Hole

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