Prescription Coverage Basics
What’s the Coverage Gap?
If you have prescription coverage, it’s important to understand the coverage gap because with the majority of Medicare plans, you pay most of your drug costs during this time.
Here’s what you need to know about the coverage gap.
Pre-Coverage Gap (Initial Coverage Period)
- This period represents regular coverage and starts immediately when your Health Alliance Medicare plan becomes active.
- You get prescription coverage with affordable copayments until you reach the coverage gap.
Coverage Gap
- When your total yearly drug costs (this is both what you and your plan pay) reach a certain amount, you enter the coverage gap period.
- For 2012 this amount is $2,930, so when your total yearly drug costs (both what you and your plan have paid) reach $2,930, you enter the coverage gap.
- During this time, you pay most of your prescription drug costs until you reach the catastrophic coverage period (see Post-Coverage Gap).
Post-Coverage Gap (Catastropic Coverage)
- Also called the catastrophic coverage period, this period comes after the coverage gap and starts when your total pharmacy spending in a year (called your yearly out-of-pocket drug costs) reaches a certain amount.
- For 2012 this amount is $4,700, so when your yearly out-of-pocket drug costs reach $4,700, you leave the coverage gap and enter the catastrophic coverage period.
- This period lasts the rest of the year, and your plan pays for most of your drug costs.