Speak with a Licensed Insurance Agent
Have questions? We can help!
Call to speak with a licensed insurance agent.
1- TTY 711Touch to Call
If you have Medicare prescription drug coverage, you need to be aware of the Medicare Part D coverage gap, also known as the “donut hole.” This is a period of time when you might have to pay more for your prescription medications.
Not everyone will encounter the coverage gap. It begins after you and your plan have spent a certain amount for your prescription drug coverage, and ends when you’ve reached a different spending threshold.
Once you’ve entered the coverage gap, Medicare counts the following amounts toward your out-of-pocket spending for the year:
In 2019, 95% of the price will count as out of pocket costs. This includes the 25% you pay and the 70% manufacturer discount payment.
The manufacturer’s discount should show up on the Explanation of Benefits document that Medicare sends you every month that you’ve bought prescriptions. If you don’t see a discount listed for a brand-name drug you bought, contact your plan and ask about it.
During your coverage gap, Medicare does not count the following amounts toward your out-of-pocket spending for the year:
If your out-of-pocket spending for Medicare Part D (as listed in “What counts toward the coverage gap (donut hole) spending threshold” above) totals $5,100 (in 2019), you’ll pay only a small coinsurance or copayment for your medications for the rest of the year.
If you need help paying for your medications:
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
eHealth´s Medicare website is operated is operated by eHealthInsurance Services, Inc., a health insurance agency licensed to sell Medicare products.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.
You must continue to pay your Medicare Part B premium.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.
Benefits, premiums and/or copayments/co-insurance] may change on January 1 of each year.
The pharmacy network may change at any time. You will receive notice when necessary.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.