What percentage do insureds pay for prescription drugs once they reach the coverage gap in Part D?

What percentage do insureds pay for prescription drugs once they reach the coverage gap in Part D?

• A. 10%
• B. 20%
• C. 25%
• D. 100%

Answer: (C)

When beneficiaries reach the coverage gap, also known as the donut hole, in Medicare Part D plans, they are responsible for paying 25% of the costs for their prescription drugs. This percentage reflects a significant change from previous years, where beneficiaries were responsible for higher percentages. The coverage gap starts after the beneficiary and the drug plan have spent a certain amount on covered drugs. Once in the gap, beneficiaries enter a phase where they must pay a larger share of their drug costs until they reach the catastrophic coverage threshold. Understanding this 25% payment is crucial as it can significantly impact a beneficiary's overall out-of-pocket expenses for medications. The context of the coverage gap is important to grasp how Medicare Part D is structured, especially in regard to cost-sharing in different phases of the plan.

When beneficiaries reach the coverage gap, also known as the donut hole, in Medicare Part D plans, they are responsible for paying 25% of the costs for their prescription drugs. This percentage reflects a significant change from previous years, where beneficiaries were responsible for higher percentages. The coverage gap starts after the beneficiary and the drug plan have spent a certain amount on covered drugs. Once in the gap, beneficiaries enter a phase where they must pay a larger share of their drug costs until they reach the catastrophic coverage threshold.

Understanding this 25% payment is crucial as it can significantly impact a beneficiary's overall out-of-pocket expenses for medications. The context of the coverage gap is important to grasp how Medicare Part D is structured, especially in regard to cost-sharing in different phases of the plan.