How To Avoid the Medicare Prescription Drug Insurance Gap or The “Uninsured Gap”

How To Avoid the Medicare Prescription Drug Insurance Gap or The “Uninsured Gap”

Many independent Medicare Part D policies and Medicare Advantage Prescription drugs have a gap in Part D benefits, also known as the “donut hole” of Medicare. During this shortage of prescription drugs, participants may need to pay a greater chunk of the cost of their prescription drug till they attain the catastrophic insurance stage of their policy.

What is the Medicare insurance gap or the “uninsured period”?

The Medicare insurance gap or “uninsured period” is a temporary limitation on which drug policies are paid for eligible drugs.

Every year, Medicare Part Dbeneficiaries can insure the prescription gap if they and their policy havepaid a certain amount for insured drugs. Get quotes for a Humana advantage plan at

In the Medicare insurance gap,beneficiaries have to pay a percentage of their drug costs. On the basis of theprovisions of the Affordable Care Act, participants will be paying a lesserpercentage for drugs every year while under the insurance gap, until 2020. Atthis point, beneficiaries are estimated to pay 25% of the cost of drugs after achieving the insurance gap.

The insurance gap terminates when the cost of the drugs in the policy for a beneficiary reaches a certain threshold, which may change every year. The beneficiary at this point enters the catastrophic insurance phase. (kindly note that whatever is spent on medicines not included in the formula of the policy, will not be included in the total threshold).

 As soon as the beneficiary gets to the catastrophic insurance phase of Medicare Part D or prescription drugs of Medicare Advantage, he or she will only be responsible for a small co insurance or co payment on supplement for the remainder of the year.

Can the Medicare insurance gap be avoided?

Not everyone will enter the Medicare insurance gap every year. For Medicare beneficiaries who receive additional costs for Part D costs, this insurance gap will not materialize. In addition, the supply gap is being reduced and degraded slowly over time as a result of the Affordable Care Act.

However, for those affected, there are ways in which you can avoid reaching the insurance gap every year:

  • Inquire from local pharmacies whether they sell your drugs at a reduced cost.
  • Verify that using a mail-order pharmacy for a 3-month supply of drugs can reduce the initial payments.
  • Ask your doctor if your medications have cheaper generic options.
  • Always use a preferred pharmacy if you have a prescription drug policy.
  • Get help from private, government or federal programs that help with the costs of medications.

Some pharmaceutical companies also offer programs for their own medications.

Do not be too alarmed by the lack of Medicare Part D insurance. With a prescription drug policy, you can still save money on your medications.

Get in touch with a broker to explain to you what options of policies would function well for you. A broker will be your best bet as he is well versed in the area of Medicare insurance plans.