The Medicare Part D coverage gap, commonly known as the doughnut hole, establishes a temporary limit on prescription drug expenses for Medicare patients once a co-payment trigger has been met. A chart from eHealth Medicare lists the 2014 trigger at $2,850.
The drug coverage limit is a discretionary amount established by Medicare that may change annually, and new coverage periods begin every on January 1st. When a person reaches the limit and falls into the coverage gap, he must pay additional out-of-pocket expenses for his prescriptions. Discounted rates on generic and brand-name drugs become available during this time, as explained by Medicare.gov, which is the official U.S. government site for Medicare. Reaching new out-of-pocket expense limits eventually helps a patient escape the coverage gap.
Once a patient is beyond the coverage gap, his co-payment decreases and Medicare Part D resumes standard payments of covered drug expenses. Despite insurance benefits, prescription costs are unaffordable for many people. Some supplemental Medicare drug plans pay a portion or all of a patient’s out-of-pocket expenses regardless of the co-payment requirements. Extra Help is a government subsidy program for Medicare recipients with limited resources who reside in the United States, as described by the Social Security Administration.