What is the coverage gap?

Medicare prescription drug coverage has three different phases of coverage — initial coverage, the coverage gap, and catastrophic coverage.

Initial Coverage

During initial coverage, your prescription drug coverage works like health insurance. Once you meet your deductible (if applicable), you pay copayments/coinsurance for your drugs based on what tier they fall under, and we pay the rest.

Talk to your doctor about generic drugs for extra savings, or look at ways to save on our plans.

The Coverage Gap

The coverage gap, also called the donut hole, is a temporary limit on what a plan will cover for drugs. It begins after you and your drug plan have spent a certain amount on covered drugs. Not everyone will enter the coverage gap.

Catastrophic Coverage

In catastrophic coverage, you only pay a small coinsurance or copayment for drugs for the rest of the year after you leave the coverage gap.

If you are receiving Extra Help, you won't enter the coverage gap.