Question

Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not changed, he is keeping the same Part D plan and the benefits, cost-sharing, and coverage of his drugs are all the same as last year. He asked what to expect for this year about his out-of-pocket costs. What information could you provide him?

Answer 1

Mr. Katz can expect his out-of-pocket costs for prescription drugs to be lower this year due to the discounts in the Part D coverage gap and the subsequent catastrophic coverage phase.

Step-by-step explanation:

To determine what to expect for out-of-pocket costs this year, Mr. Katz needs to understand how the Part D coverage gap, or the "donut hole," works. In 2021, once a Medicare beneficiary reaches the coverage gap, they will pay no more than 25% of the cost for generic and brand-name drugs. This applies to both brand-name and generic drugs. After reaching a certain out-of-pocket spending limit, Mr. Katz will then enter the catastrophic coverage phase, where he will pay significantly less for his medications for the remainder of the year.

Therefore, even though Mr. Katz reached the coverage gap last year, he can expect his out-of-pocket costs for the same prescriptions to be lower this year due to the discounts in the coverage gap and the subsequent catastrophic coverage phase. It's important for him to review his Part D plan details to confirm the specifics of his coverage.

Learn more about Part D coverage gap