| Medicare Prescription Drug Plans (Part D) are optional plans sold by private insurers approved by Medicare. You must use drugs on their approved list. You get Part D coverage by joining a separate Prescription Drug Plan or by joining a MA Plan that includes drug coverage as part of its benefits.
The Donut Hole
 Medicare drug plans have a coverage gap, called a "donut hole." This means that after you and your plan have spent a certain amount (for example, $2510), you pay all costs until you reach the plan's out-of-pocket maximum (for example,$4050). Once you reached the maximum, you have "catastrophic coverage" and only pay a coinsurance/copayment amount for the rest of the year. Some plans cover your drugs through the gap. When choosing a plan, compare drug coverage, cost, and pharmacy locations.
Your Coverage During a Health Plan Change
If you switch drug plans, your new plan must cover your Part D drugs through a 30-day transition period, even if your drug is not on their approved list. During this period, your doctor will recommend similar drugs on the plan’s approved list. After the transition period, if your drug is still not on the approved list or you don’t get prior approval from the plan, your new plan will not pay for the drug. |
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