Medicare Coverage Gap – How To Avoid The Medicare Part D Donut Hole

Avoiding the Medicare coverage gap starts with enrolling in the right Medicare Part D Plan. This video shows you how to avoid or at least delay getting into the Part D donut hole.

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The Medicare Part D coverage gap may seem harsh, but you can avoid or delay the coverage gap by choosing the right Part D plan for your circumstances and following some simple steps.

The Medicare Coverage gap is determined by the Part D Standard Benefit Model. This model, developed by CMS determines how all Medicare Part D plans will work.

The maximum allowed Part D deductible, initial coverage limit (when you reach the donut hole), the out-of-pocket threshold amount (when you exit the donut hole) and catastrophic cost-sharing amounts are set annually.

For 2014 plans, you will reach the Medicare coverage gap when you and your plan have spent $2850. Once in the Part D coverage gap, you will be responsible for the next $4550 in drug costs.

You will have a little help from ObamaCare. The Part D donut hole will gradually close by 2020. In 2014 you will receive a 52% discount on generic drugs and will pay no more than 72% for brand-name drugs while in the donut hole.

Watch: Medicare Part D — 5 Things to Know Before You Enroll in a Part D Plan –

How to avoid the Medicare coverage gap:

Compare Part D options every year. Plans are annual and costs, benefits and covered drugs can change each year.

Use a drug look-up tool. Compare tier placement for each of your prescriptions.
Speak with your provider for less expensive alternatives.

Use preferred pharmacies.

Take advantage of your plan's Part D mail order program.

Continue to show your card, even if you are in the Part D coverage gap.

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