• For 2011 you indicate that the full retail cost of drugs while in the donut hole will apply to the amount required to get out for name brands even though I'm only paying 50%. I talked directly with Medicare and they said I will still have the same out of pocket requirements, i.e. it'll just essentially take me twice as long. Can you clarify?
The Medicare representative is correct in saying that your requirement (out-of-pocket cost limit or TrOOP) to get out of the coverage gap will not change in 2011. It will rema...
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• My current prescription drug retail cost are $230 per month. What will be my discount in the Doughnut Hole?
If your total retail prescription medication costs are under $236, you will not exceed your plan's Initial Coverage Limit ($2,840 per year for 2011) and so you ...
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• Can you provide an example of the 2011 Donut Hole Discount?
We have updated our 2011 PDP-Planner (or Donut Hole Calculator) to include the model plan features for 2011. We have several example online and you can click here f...
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• Will monthly Medicare Part D premiums increase due to the manufacturer’s discount on brand-name drugs purchased in the Coverage Gap?
CBO says Yes. The Congressional Budget Office (CBO.gov) has issued the following statement:“The Patient Protection and Affordable Care Act (PPACA) introduced a manufactu...
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• I have a PACE plan, will I get the discount on brand-name drugs purchased in the Coverage Gap?
No. The manufacturer discount on brand-name drugs purchased in the Coverage Gap is applied AFTER the plan’s supplemental coverage. In the example of a PACE plan, P...
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• Does everyone receive a discount in the Coverage Gap?
No. Only Medicare beneficiaries enrolled in a Medicare Part D prescription drug plan (PDP) or a Medicare Advantage plan that offers a prescription benefit (MA-PD)
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• Which brand name prescription drugs are eligible for the 2011 Coverage Gap or Donut Hole discount?
All brand-name Medicare Part D drugs. According to the Affordable Care Act, only those brand drugs from manufacturers who have agreed to participate in the Doughnut Hole...
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• Will the Coverage Gap discount program affect which brand drugs are offered under Medicare Part D?
Maybe. Beginning January 1, 2011, the Affordable Care Act limits Medicare Part D coverage for applicable drugs to only those drug manufacturers that have an agreement with CMS...
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• Who is really paying for the discount on drugs purchased in the Coverage Gap?
The discount for brand-name drugs purchased in the Coverage Gap will be ultimately paid by the manufacturer.Medicare (that is, the Center for Medicare and Medicaid Services) w...
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• If I go into the 2011 Coverage Gap, will my Doughnut Hole discount be deducted at the pharmacy or will I get a refund from my Part D plan?
You will receive the discount directly at the Pharmacy. The 2011 discount on medications purchased in the Coverage Gap will be calculated at the point-of-sale (or Pharmacy).
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• Since all 2011 Medicare Part D plans will now have a 7% Coverage Gap discount for generics, will there no longer be plans with a Coverage Gap description of “No Gap Coverage”?
No. The description of the gap coverage offered by the plan is above and beyond the 7% discount.So for 2011 plans, even if the Part D plan's gap coverage type is “No Gap...
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• I have a Medicare Part D plan that provides coverage for some generics while I am in the Coverage Gap, will this same Doughnut Hole coverage apply to all generics in 2011?
No. Even if your Medicare prescription drug plan offers coverage for some generics in the Coverage Gap (for example, you pay a $5 co-pay for all Tier 1 generics), your Medicar...
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• Will generic “Bonus Drugs” and generic drugs excluded by Medicare also receive the 7% Coverage Gap discount?
No. The 7% generic drug Doughnut Hole discount, also known as the standard benefit, does not apply to Medicare Part D excluded drugs even if they are covered by the Medicare P...
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• Will all Generic drugs get the Coverage Gap discount or only generics drugs in Tier 1 or the lowest formulary tier?
All Plan Normal Formulary Generics will receive the Doughnut discount. The 7% discount on generic drugs in the 2011 Coverage Gap applies to all generics treated as formu...
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• Will the Coverage Gap or Donut Hole eventually close?
Yes. Although medications will never be “free” in the Coverage Gap, Medicare states that, “[b]y 2020 the coverage gap will effectively be closed for generics...
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• What kind of discount can we expect in the 2011 Doughnut Hole?
A 50% discount on Brand drugs and 7% discount on Generic drugs. Starting in the 2011 Medicare Part D plan year, the co-insurance (or cost-sharing) will be reduced for non-LIS ...
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• What exactly is TrOOP or True Out of Pocket costs?
The Centers for Medicare and Medicaid Services (CMS) explain that,"True out-of-pocket (TrOOP) costs are the expenses that count toward a person’s Medicare drug plan...
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