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How Part D Works-The Coverage Gap

Understanding Part D and How It Works


Most Prescription Drug Plans have a coverage gap called a 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. For 2021, you're in the coverage gap once you and your plan have spent $4,130 on covered drugs. People with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

Once you reach the coverage gap in 2021, you'll pay 25% of the plan's cost for covered brand-name prescription drugs and generic drugs. You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plans have set with the pharmacy for that specific drug.

Choosing a plan


It pays to review your Part D coverage every year, especially if you have started taking new drugs.


Let's talk about what your needs are and what is most important to you. We'll explore plans that will provide Medicare solutions to meet those needs. 


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