Medicare Part D is designed to pay for all of a senior’s prescription drug costs. However, Medicare Part D will not cover prescription drug spending after a certain limit- 3,610$(this may vary by insurer). After a senior spends more than $3,610 then Medicare will no longer pay for their prescription drug costs. This is the coverage gap limit and in 2007, an estimated 3.4 million Part D seniors had reached the coverage gap limit. However, there is a way for a senior to regain Medicare health insurance coverage after reaching the coverage gap.
After seniors reaches the coverage gap, they may still be able to resume Medicare Part D coverage if they spend enough money on prescription drugs. Catastrophic coverage starts after a senior has incurred $6440.00 in prescription drug costs. Medicare Part D will resume paying 95 percent of a senior’s drug cost after they have gone under catastrophic coverage.
Harry believes that because he is covered by Medicare Part D, he can incur high prescription drug costs while he is extremely illl. Harry thought that Medicare Part D would cover all of his costs because he didn’t know about the coverage gap. Tragically, Medicare Part D stopped paying for Harry’s prescription drug fees because he spent more than $3,610. Now Harry has to pay for all his prescription drug fees out-of-pocket. Eventually, Harry spends more than $6,440 in prescription drugs he qualifies for Medicare Part D’s catastrophic coverage. With catastrophic coverage, Harry only has to pay 5 percent of his prescription drug fees. When Harry was spending more than $3,610 but less than $6,440 he was in the coverage gap. After spending more than $6,440, his Medicare Part D coverage resumed under catastrophic coverage.
The Patient Affordable Care Act passed in March 2010 by the U.S. Congress will try to close the coverage gap. It proposes to gradually close the gap over a span of ten years relating to Medicare health insurance.