Question: What kind of discount can we expect in the Doughnut Hole?
Answer: Starting with the 2011 Medicare Part D plan year, the co-insurance (or cost-sharing) was reduced for non-LIS Medicare beneficiaries on covered drug purchases in the Coverage Gap (or Donut Ho...
|
Question: 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%. Can you clarify?
Answer: Complete Question: 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 talk...
|
Question: I use a brand name drug, but it is not covered by my Medicare Part D plan. Will the 50% discount on brand-name drugs still apply to this drug when I am in the Donut Hole?
Answer: No. The Donut Hole discount only applies to medications that are included on your Medicare prescription drug plan’s formulary or drug list.
If you wish to have your non-formulary medi...
|
Question: I asked my pharmacist about the new discount program and he did not seem to know anything about it. So will I still receive this 50% discount on my refills while I am in the doughnut hole or do I need to find another pharmacy?
Answer: Complete Question: I use one expensive medication that cost almost $2000 a month and I have already reached my Doughnut Hole for this year. I asked my pharmacist about the new discount program and he ...
|
Question: Does the Donut Hole Discount apply to a retail drug purchase that straddles my Medicare Part D plan's Initial Coverage phase and the Coverage Gap or Donut Hole phase? In other words, does the Donut Hole discount apply to a Straddle Claim?
Answer: Yes. If the negotiated retail price of your medications moves you from the Initial Coverage phase of your Medicare Part D prescription drug plan into the Coverage Gap or Donut Hole phase; you ca...
|
Question: How much do I have to pay for generics in the donut hole in 2011, 2012, 2013,2014, 2015, etc. until it reaches 25%
Answer: Even if your Medicare Part D plan has no coverage in the gap, starting in 2011, you receive a discount on your medications while in the coverage gap. For generic drugs, you would pay the following p...
|
Question: My current prescription drug retail cost are $230 per month. What will be my discount in the Doughnut Hole?
Answer: 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 will not need to take adv...
|
Question: Can you provide an example of the 2011 Donut Hole Discount?
Answer: 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 for an example of a Medica...
|
Question: Will monthly Medicare Part D premiums increase due to the manufacturer’s discount on brand-name drugs purchased in the Coverage Gap?
Answer: CBO says Yes. The Congressional Budget Office (CBO.gov) has issued the following statement:“The Patient Protection and Affordable Care Act (PPACA) introduced a manufacturer discount program in M...
|
Question: I have a PACE plan, will I get the discount on brand-name drugs purchased in the Coverage Gap?
Answer: 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, PACE pays 100% of the nego...
|
Question: Does everyone receive a discount in the Coverage Gap?
Answer: 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 enrol...
|
Question: Which brand name prescription drugs are eligible for the 2011 Coverage Gap or Donut Hole discount?
Answer: 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 discount program will be...
|
Question: Will the Coverage Gap discount program affect which brand drugs are offered under Medicare Part D?
Answer: 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 to participate and pay d...
|
Question: Who is really paying for the discount on drugs purchased in the Coverage Gap?
Answer: 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) will provide monthly payme...
|
Question: 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?
Answer: 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).
However, calculating the ...
|
Question: 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”?
Answer: 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 Coverage” the plan...
|
Question: 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?
Answer: 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 Medicare Part D plan is not requ...
|
Question: Will generic "Bonus Drugs" and generic drugs excluded by Medicare also receive the 7% Coverage Gap discount?
Answer: 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 Part D prescription drug p...
|
Question: Will all Generic drugs get the Coverage Gap discount or only generics drugs in Tier 1 or the lowest formulary tier?
Answer: 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 formulary drugs in the initial...
|
Question: Will the Coverage Gap or Donut Hole eventually close?
Answer: 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; beneficiary cost-sharin...
|
Ready to Enroll?
