the gap in coverage when the enrollee has to pay 100% of the discounted price. It is the period after an enrollee's drug spending exceeds the initial coverage limit and before the enrollee's out-of-pocket expenses reach the TrOOP limit. This is referred to as the donut hole or coverage gap.
A name for the step in a standard Medicare drug plan in which you pay 100% of your expenses for eligible drugs, until your out-of-pocket drug costs have reached $3,600. Some people call this step the "doughnut hole."
After the member and the insurance plan have together paid for $2,250 in drug costs, the member must pay 100% of the drug costs, until the total out-of-pocket cost for the member reach $3,600. This time is referred to as the coverage gap, since the member is paying 100% of the costs.
The portion of the Part D benefit structure in which beneficiaries pay 100% of their Part D medication expenditures. The coverage gap begins when total spending for drugs reaches $2,250, exclusive of the beneficiary's monthly premium, and it ends when total spending for drugs reaches $5,100 (generally equal to $3,600 in total out-of pocket spending for drugs). This is also called the "Doughnut Hole."
The term given to the coverage gap in Medicare Part D between $2,250 and $5,100 of total prescription drug expenses that requires beneficiaries to pay up to $2,850 ($5,100 - $2,250) of their drug costs. Above the $5,100 stop -loss limit is considered catastrophic coverage. At this point, Medicare beneficiaries would have spent $3,600 out -of -pocket on prescription drugs (between the Part D deductible, coinsurance, and uncovered drug costs in the doughnut hole) and would then be responsible for paying the greater of a $2 co-payment for generics and $5 for brand drugs or 5% coinsurance.
The gap between the initial coverage limit and the catastrophic level. While in the coverage gap, you pay 100% of discounted drug cost until you reach the catastrophic level, unless you have selected a plan that provides coverage during this period.
A name for the step in a Part D plan in which you usually pay all of your expenses for eligible drugs, until you have spent $2,850. Some people call this step the donut hole.
Medicare drug plans may have a "coverage gap," which is sometimes called the "donut hole." A coverage gap means that after you and your plan have spent a certain amount of money for covered drugs (no more than $2,400), you have to pay out-of-pocket all costs for your drugs while you are in the "gap." The most you have to pay out-of-pocket in the coverage gap is $3,051.25. This amount doesn't include your plan's monthly premium that you must continue to pay even while you are in the coverage gap. Once you've reached your plan's out-of-pocket limit, you will have "catastrophic coverage." This means that you only pay a coinsurance amount (like 5% of the drug cost) or a copayment (like $2.15 or $5.35 for each prescription) for the rest of the calendar year. Note: If you get extra help paying your drug costs, you won't have a coverage gap. However, you will probably have to pay a small copayment or coinsurance amount.
