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How the Gap May Affect You
www.YourPharmacyBenefit.org
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What is the Coverage Gap?
The coverage gap (sometimes called the
“donut hole”) is when Medicare temporarily stops paying for your
prescriptions and you have to pay the entire cost yourself. The
coverage gap is only likely to affect about 8% of Medicare
beneficiaries and only applies to those who have Medicare prescription
drug coverage.
You
may see little or no impact from the coverage gap if:
- You
have very low drug costs each year.
- You
have “extra help” (limited income subsidy) from Medicare or the Social
Security Administration.
- You
have Medicaid. (You may qualify for Medicaid part way through the year
if your out-of-pocket spending on medicines or other healthcare
significantly reduces the income you have left for living expenses.)
- You
have coverage from a state program in addition to Medicare.
- You
have an “enhanced” Medicare prescription drug plan or a Medicare
Advantage Plan that provides extra coverage during the gap, possibly
even eliminating it. You may switch to one of these plans during the
next enrollment period (November 15 through December 31, 2007).
Some drug companies offer
financial assistance for their medicines. To apply for these programs,
visit www.helpingpatients.org, or call the
Partnership for Prescription Assistance at 1-888-477-2669.
If you think you may be
affected by the coverage gap, read on to find out more about how it
works.
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