After you and your Part D coverage have paid a certain amount of prescription drugs ($ 2850 in 2014), you will get 47.5% of brand name drugs and 72% of generic drugs. This is called the coverage gap or the period without coverage.
Once your out-of-pocket expenses (as defined by Medicare) reach $ 4,550 (in 2014), myaarpmedicare login united health you are automatically in the catastrophic coverage phase. This means that for the rest of that particular year, you will only pay a small copayment or coinsurance for prescription drugs.
The table below illustrates the three stages of a prescription drug plan:
Stages of prescription drug costs
Total drug costs: the amount you pay and the plan pays for prescription drugs. This does not include bonuses.
Out-of-pocket costs: the amount you pay and the plan pays for brand name drugs, and what you only pay for generic drugs. This does not include bonuses.
Keep in mind that Medicare Part D coverage may vary from one plan to another. Some medications (for example, brand-name drugs vs. generic medications) are covered at different levels. Each insurance company determines which medication is covered at what levels.
Medicare Prescription Drug Plan Donut Hole
The coverage gap begins when the total costs of your drugs, including those you and your plan have paid for the drugs, reach a certain amount since the beginning of the calendar year. In 2014, this amount is generally $ 2,850.
When it reaches this amount, it reaches the coverage gap. As a result of health reform, you get discounts to help pay for your drugs during the coverage gap. In 2014, there is a discount of 52.5 percent from the manufacturer on most brand name drugs. This means that you pay 47.5 percent for the brand name drugs on your Part D plan's formulary, and the manufacturer and the federal government pay 52.5 percent together. For generic drugs, the government offers a discount of 28 percent in 2014. You pay the remaining 72 percent of the cost.
These discounts will increase gradually each year until 2020. Starting in 2020, you will generally pay more than 25 percent of the cost of your medication at any time during the year after you have met your deductible.