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Coverage Gap
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Most Medicare drug plans have a coverage gap. This means that after the senior and the drug plan have spent a certain amount of money for covered drugs, the senior must pay all costs out-of-pocket for prescriptions up to a yearly limit. The yearly deductible, coinsurance or copayments, and what is paid in the coverage gap all count toward this out-of-pocket limit. The limit doesn't include the drug plan's premium or the amount what you pay for drugs that aren't on your plan's formulary. 

There are plans that offer some coverage during the gap, like for generic drugs. However, plans with gap coverage may charge a higher monthly premium. Seniors should check with the drug plan first to see if their drugs would be covered during the gap. 

For help comparing plan costs, contact the State Health Insurance Assistance Program (SHIP) or visit and select "Compare Medicare Prescription Drug Plans."
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