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In the coverage gap, the member pays what percent for generic drugs?

User Drew Sears
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Final answer:

The 'coverage gap' in prescription drug plans involves members paying a higher percentage for generic drugs after exceeding the initial coverage limit. Percentages can vary, thus one should check latest Medicare information for current rates.

Step-by-step explanation:

The question pertains to the coverage gap, also referred to as the 'donut hole', in a prescription drug plan. This term is often associated with the Medicare Part D coverage.

While specific percentages can fluctuate over time due to legislative changes, traditionally, after an individual reaches the initial coverage limit and before the catastrophic coverage kicks in, they are in the coverage gap. During this period, individuals have to pay a greater portion of their prescription drug costs.

In the past, members would pay a higher percentage for both generic and brand-name drugs while in the coverage gap; however, recent changes aim to reduce the cost burden on Medicare beneficiaries when they reach this stage. Members are eligible for substantial discounts on the cost of medications; although, they still pay a larger share than before reaching the limit.

It is important to consult the most recent Medicare information or a healthcare professional to receive up-to-date percentages regarding the member's responsibilities for generic drug costs in the coverage gap. As these figures can change with new healthcare legislation or policy adjustments, staying informed through reliable sources is crucial.

User David Taub
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