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Questions & Answers (FAQ)


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Search & Browse > FAQ Home > Closing the Coverage Gap

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Does everyone receive a discount in the Coverage Gap?
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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)

  • and who are not enrolled in a qualified retiree prescription drug plan
  • and are not entitled to an income-related subsidy (LIS)
  • and who have reached or exceeded the Initial Coverage Limit during the year
  • and have not yet entered the Catastrophic Coverage phase of their prescription drug plan coverage

    . . .will receive the discount.


Please note that enrollees in Employer group health and waiver plans may also eligible for participation in the Discount Program.


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Related FAQs In This Category
• 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?
• 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”?


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Customer Helpdesk

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Latest Added FAQs

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  . . .

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&nbs . . .

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 featu . . .

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:“Th . . .

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 . . .





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