What are gaps in coverage with Medicare?
Medicare Coverage Gaps
Medicare is a federal health insurance plan for people 65 and older, or with certain disabilities. The main Medicare plans are called A, which covers hospital services, and B, which pays for doctor visits, lab tests, and other outpatient services.
- Original Medicare doesn’t cover some essentials. For instance, it does not pay for most prescription drug costs.
- Even when Medicare covers a treatment, you still have to pay co-pays (a fixed amount you pay for some services) and coinsurance (a percentage share of the medical bills not covered Medicare).
- Most people have to pay a monthly fee, called a premium, for Medicare Part B.
Five Ways to Avoid the Medicare Part D Coverage Gap
1. Buy generic prescriptions.
Many common brand-name medications have generic alternatives available, and they are often less expensive. Generic drugs are required the Food and Drug Administration to have the same ingredients as the brand-name version, at the same dosage, be administered the same way, and be proven to have the same effect. Ask your doctor or health-care provider if any of your prescriptions can be switched to generics.
2. Order your medications mail and in advance.
Many Medicare Part D prescription drug plans offer medications at a discount if you order a three-month supply mail instead of picking up a 30-day supply at the pharmacy. Sometimes, a local pharmacy can even offer a 90-day supply of your prescription at the same price as the mail-order plan. It’s worth looking into the different options and comparing the per-pill cost of the bulk options. Some drugs can’t be prescribed in larger supplies, but for those that can, you may find valuable cost savings.
3. Ask for drug manufacturer’s discounts.
Some pharmaceutical companies offer their products at a discount directly to consumers or through doctor’s offices. This is more common for brand-name and specialty drugs, which can be expensive. Ask your doctor or health-care provider when you get the prescription if any discounts are available or if there is a pharmaceutical assistance program. You can also search online as the drug manufacturer’s website may have more information.
4. Consider Extra Help or state assistance programs.
If you qualify, the Extra Help program (also called the Low-Income Subsidy program) can provide financial assistance with Medicare Part D costs. You must have limited income and assets to qualify, and the specific qualification threshold may change each year. Some states also have assistance programs, and these vary in how you qualify and apply. More details can be found at Medicare.gov’s pharmaceutical assistance program page.
5. Shop around for a new prescription drug plan.
Every fall, your plan will send you an Annual Notice of Coverage. Take a look at it and see if your plan has changed your prescription drug coverage or costs.
Even if your plan coverage hasn’t changed, you might want to compare Medicare prescription drug plans in your area. You might be surprised to find a plan with better coverage for your needs.
If you want more tips or you have more questions related to Medicare Coverage gaps, Talk to our experienced Medicare coverage gap agents. Contact us now, call us on +1 (216) 236-1466 or Text our live agent +1 (330) 443 1071. We are here to support you in all your concerns