Question

Which of the following statements is NOT true about the Coverage Gap?

a Some plans offer additional coverage through the coverage gap, usually at a higher monthly plan premium The use of lower cost generic medications may prevent the member from reaching the coverage gap
b For 2022, the coverage gap begins when the member has incurred $4,430 in medication spending for the year
c If a member reaches the coverage gap, they will have access to the Plan's negotiated pharmacy discount rate for Medicare Part D medications
d All members reach the Coverage Gap

Answer 1

The false statement about the Coverage Gap is that all members reach it. This gap in Medicare Part D occurs when a member incurs a certain amount in drug costs for the year and not everyone will reach it.

Step-by-step explanation:

The statement about the Coverage Gap that is NOT true is "All members reach the Coverage Gap." The Coverage Gap, also known as the Medicare Part D 'donut hole,' is a period during which there is a temporary limit on what the drug plan will cover for drugs. Not all members will reach this gap; it depends on the individual's yearly medication costs. In 2022, the Coverage Gap began when a member incurred $4,430 in medication spending for the year. While some plans may offer additional coverage within this gap, it is typically at a higher premium. Members who do reach the Coverage Gap will have access to discounted prices, and using lower-cost generic medications may prevent some from reaching the gap altogether.