What Is the Medicare Coverage Gap?
Original Medicare coverage did not cover prescription drugs. The Medicare Prescription Drug Improvement and Modernization Act of 2003 created Medicare Part D, Medicare’s Prescription Drug Plan, to fill this coverage gap. Beneficiaries have discovered coverage gaps they still must contend with.Gap Creates Doughnut HoleThe Prescription Drug Plan (PDP) covers the first $2,830 in prescription costs after a $310 deductible and co-pays. If prescription costs for the year exceed $2,830, the PDP plans covers no more costs that year until the PDP participant has paid $4,550 out of pocket.Doughnut CrumbsOf the 1,576 plans serving different areas of the nation, about one fourth offer some coverage within the doughnut hole, such as for generic drugs and some drug discounts.Hole FillersLow-income recipients can apply for the Medicare Part D Extra Help program, administered by the Social Security Administration. If individuals qualify for its help paying their PDP premiums, they are exempt from the
