Amounts paid by others, including family members, most charities, and other persons on your behalf.Almost the full cost of brand-name drugs (including the manufacturer’s discount) purchased during the coverage gap.What you paid during the initial coverage period. The out-of-pocket costs that help you reach catastrophic coverage include: During this period, you pay significantly lower copays or coinsurance for your covered drugs for the remainder of the year. This amount is made up of what you pay for covered drugs and some costs that others pay (see below). In all Part D plans, you enter catastrophic coverage after you reach $7,400 in out-of-pocket costs for covered drugs. For example, if a drug’s total cost is $100 and you pay your plan’s $20 copay during the initial coverage period, you will be responsible for paying $25 (25% of $100) during the coverage gap. In the past, you were responsible for a higher percentage of the cost of your drugs.Īlthough the donut hole has closed, you may still see a difference in cost between the initial coverage period and the donut hole. The donut hole closed for all drugs in 2020, meaning that when you enter the coverage gap you will be responsible for 25% of the cost of your drugs. While in the coverage gap, you are responsible for a percentage of the cost of your drugs. You enter the donut hole when your total drug costs-including what you and your plan have paid for your drugs-reaches a certain limit. The Medicare Part D donut hole or coverage gap is the phase of Part D coverage after your initial coverage period.
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