Are the Part D Plans comprehensive or are there gaps in coverage?
It depends upon the particular plan, but according to a model presented by the government, there will be gaps in Part D coverage. Under the federal government's Part D cost model, a plan may charge you a deductible of $310 in 2011.

Once you have met the deductible or if the plan does not charge a deductible, you enter into what is known as the co-insurance phase. You now will pay either 25% of the cost of your drugs or an amount that is based on a tier structure. You remain in this phase until the full cost of your drugs reaches the amount of $2,840. This amount is calculated based on the full cost of your drugs, not just your out-of-pocket costs. In other words, what you and the insurance company has paid.

When the full cost of $2,840 is met, you now go into the gap. This gap in coverage is commonly referred to as the "doughnut hole." because of the recent reform in Health Care, in 2011 you will no longer have to pay the full cost of your drugs. There will be a 50% cost reduction on brand named drugs and a 3% reduction on the cost of generic drugs in this phase.

Once you have spent a total $4,550 out-of-pocket, the plan pays 95% and you pay 5%. This last part is referred to as "catastrophic coverage." It's important to note that these figures only include the cost of prescriptions covered by your drug plan. If your Part D plan does not include a particular prescription on its list of covered medications (known as a formulary) and you purchase that prescription, you will pay the total cost of the prescription and that amount does not count towards your Part D coverage limits.

The government calls this model the "standard plan." Providers will be allowed to make plan that are a little different from the standard plan, so your particular options may look different. It is also worth noting that if you qualify for "extra help" (the Part D financial assistance program), the government covers a significant portion of your Part D plan costs and you will not be required to make the same payments as other Part D standard plan participants.

Show All Answers

1. What is Medicare Part D?
2. Who is eligible for Part D benefits?
3. Who will provide my prescription drug coverage?
4. Is participation required?
5. How do I know if I will have to pay a late enrollment penalty?
6. How do I sign up for a Medicare Part D plan?
7. When can I enroll in a Part D plan?
8. Can I change Part D Plans?
9. I'm married, do I apply with my spouse, or do I apply by myself?
10. Which drugs will Medicare Part D Plans cover?
11. Can a Part D Plan Provider change which drugs they cover?
12. What if I need a drug that is not covered by my Part D plan?
13. Where can I purchase prescription drugs if I enroll in Part D?
14. How much will Part D cost?
15. What can I expect to pay for my Part D Plan?
16. What is the difference between a co-pay and co-insurance?
17. Are the Part D Plans comprehensive or are there gaps in coverage?
18. What if I can not afford my Part D costs?
19. Will the rich pay more than the poor?
20. Why does it cost so much?
21. What if I am currently participating in a Medicare Savings Program such as SLMB, QMB, SLMB Plus, or a program that helps pay Medicare premiums?
22. What if I am currently receiving prescription drug coverage through SeniorCare?
23. If I currently receive prescription drug benefits through my Veterans Benefits, should I apply for Medicare Part D?