Most Medicare part D drug plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs. The coverage gap begins after you and your drug plan have spent a certain amount for covered 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. In 2023, that limit is $4,660.
The 4 stages of Medicare Part D prescription drug coverage
- Stage 1—Deductible Stage. ...
- Stage 2—Initial Coverage Stage. ...
- Stage 3—Medicare Part D Coverage Gap. (Donut hole) ...
- Stage 4—catastrophic coverage.
In the donut hole, you pay up to 25% out of pocket for all covered medications. You leave the donut hole once you've spent $7,400 out of pocket for covered drugs in 2023, and $8,000 in 2024. A $2,000 out-of-pocket cap takes effect for Medicare Part D in 2025.Nov 14, 2023
Research from KFF, an independent provider of health policy research, has also found monthly premiums for Part D will be “substantially higher” in 2024. The national average monthly Part D premium is projected to increase 21% in 2024 to $48, up from $40 in 2023, according to KFF.Nov 21, 2023
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Medicare part D plans have four parts: the deductible stage, initial coverage, the coverage gap, and catastrophic coverage. Each part resets every year.
In the deductible stage, you pay 100% of the cost of your drugs until you meet your deductible (currently, $505). Under initial coverage, you pay 25% of the cost of any covered brand name drug or generic drug on your plan’s formulary, (or less, depending on your plan). Once you have spent $4,660 on covered drugs (for 2023), you enter what was previously known as the coverage gap.
Here, you still pay 25% of the cost of all your drugs, until you get all the way through where the coverage gap used to be, according to Louise Norris, a health policy analyst for Medicareresources.org. That gap has dropped to 25%—equal what you pay under initial coverage. After you’re through the coverage gap, you’re into catastrophic coverage.
Just to make things more confusing, most plans aren’t standard designs, Norris says. Before you reach the coverage gap, there may be other parameters for how plans charge you, such as fixed copays after you hit your deductible, then a 25% co-insurance once you hit the spending threshold.
https://www.usatoday.com/story/money/personalfinance/2023/11/30/medicare-plans-dropping-insulin-may-cost-you/71623776007/