Medicare prescription drug insurance gap (Part D): the screw hole

Medicare prescription drug insurance gap (Part D): the screw hole

With the new Low-Price Health Care Act in force, many Medicare-advantage plans related issues will be subject to consistent changes. One of those issues is Medicare prescription drug insurance (part D). One of the biggest changes that is likely to occur is the insurance gap of part D: the “screw hole”. The Low Price Health Care Act contains rewards that will help make prescription drug insurance more affordable, allowing more people to reward from this policy. These rewards include:

A discount on brand name drugs when purchased at a pharmacy or by mail

Partial insurance of generic drugs

What is a screw hole, how do I get out and how to save money on it?

Most Medicare prescription drug policies have a limit on what they insure for prescription drugs. This limit is the “deck space”, also known as the “screw hole”. This insurance gap begins after you and your drug policy spend a certain amount of money on brand-name insured drugs. According to the Low Price Health Care Law, upon reaching the insurance gap, you will receive a 50% discount (in 2012) on brand name drugs and a 14% discount on generic drugs.

In the next few years, you will start paying less in the insurance gap by 2020, when the threaded hole will be completely closed. Once you reach the insurance gap limit, you are responsible for paying all out-of-pocket costs up to an annual limit until you reach “catastrophic” insurance ($ 4,700 in 2012). Your annual deductions, coinsurance/copayments and what you pay in the period without insurance count toward your annual limit, but pharmacy costs do not. However, this limit does not include your monthly premiums for your Part D policy or what you pay for drugs that are not insured by the policy.

In summary, while a person is in the gap (screw hole), he must pay all expenses for the costs of the drugs until he reaches the “catastrophic” limit: $ 4,700. Once you have reached this limit, you will only have to pay a nominal coinsurance fee for your medications for the rest of the year, which means that, statistically, once you spend $ 4,700 out of pocket, you will only be responsible for paying a small copayment for the medication. Rest of the year fortunately, there are other ways to save in the insurance gap:

You are currently registered in a Medicare prescription drug policy or a Medicare Advantage policy that includes prescription drug insurance (HMO or PPO, for example).

You do not receive “Extra Help” from the Medicare Low Income Subsidy Grant – Medicare, which provides people with limited incomes to help pay for drug costs.

You have already hit the screw hole.