SHINE (Serving the Health Insurance Needs of Everyone) is funded by the Agency for Community Living and coordinated by the Massachusetts Executive Office of Elder Affairs in partnership with the Friends of The Milford Senior Center.
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All Drug Plans are Subject to the Coverage Gag/Donut Hole
What is the Coverage Gap/Donut Hole?
The Medicare drug plans have different payments stages. The "doughnut hole" refers to a partial gap in prescription drug cost coverage under Medicare Part D or Medicare Advantage Plans.
In 2018, once you reach $3,750 in prescription drug costs (which include both your share of covered drugs and the amount paid by your part D plan) you will be in the coverage gap. In 2018, you will get a 65% discount on brand-name drugs and a 56% discount on generic prescription drugs while you are in the coverage gap. When your total out-of-pocket costs reach $7,508, you qualify for "catastrophic coverage." At that point, you are responsible for only 5% of your prescription drug costs for the rest of the year.
If you are computer literate and would like to investigate the costs of a Medicare Part D plan you can go to www.medicare.gov enter some information, and your medications you will be shown the three least expensive plans that meet your needs. You can get a easy explanation on the site by going to
NEED HELP INTERPRETING YOU PART D SEARCH RESULTS?
It can be difficult to interpret the results from the Medicare Part D Plan Finder tool at the www.medicare.gov website. If you need assistance interpreting or validating the results of your search SHINE can help. If you provide us with the Drug List IDF# and password date from your search, this is located in the top right hand corner of the search results page we will go over this information with you. We offer this assistance to those of you who have input their prescriptions into the Medicare Plan Finder Tool. Of course, we will continue to assist those of you who are unable to input their information on the Plan Finder Tool by sending one our Drug Search Tools to them and processing it when they return it to us.
Medicare Prescription Drug Plan (Part D)
Medicare Prescription Drug Plan (Part D). These plans (sometimes called "PDPs") add drug coverage to Original Medicare. These are private drug plans that contract with Medicare to provide drug coverage. These plans have premiums, some have deductibles, they have copays, and are subject to a coverage gap/donut hole
Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan. Medicare Advantage plans are subject to the donut hole.