The Coverage Gap
"the donut hole" | |
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Here’s the bottom-line on the "coverage gap" | |
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Once you and the insurance company together have spent a certain amount on prescriptions
(usually around $2,250 but this varies by plan), PDP coverage changes. You then enter the
"coverage gap", also know as the "donut hole".
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| Here’s how the "gap" works | |
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Under the standard benefit, when you and your insurance company together have spent above
$2,250 on drugs, you reach the "gap". When you are in the "gap" you pay for all of your
prescriptions yourself, until you have spent $3,600 of your own money on prescriptions
(including your co-pays). Then coverage restarts and the PDP provider will then pay for
about 95% of your remaining drug costs for that calendar year.
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| Here’s the Wellcare Advantage | |
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- WellCare helps you keep track of the "gap".
We give you a monthly statement that tracks your spending and ours. You always know
how close you are to the coverage gap.
- WellCare helps you avoid the "gap".
We offer $0 general drugs on all of our plans. Not only does this help you get the
most out of your coverage (because WellCare is paying all of your drug costs), it also
keeps costs low in general, so you won’t enter the "gap" as fast...if at all. In fact,
most people with WellCare plans won’t ever reach the "gap".
- WellCare offers extra help to those on a limited income.
If you are on a limited income and qualify for extra help from the government, you do not
have a coverage gap. Depending on the level of assistance you receive, if you reach the
initial coverage limit of $2,250, coverage changes and most people will only have a small
co-payment for generic drugs until the total expense between you and the company reaches $3,600.
Then, the co-pay returns to $0.
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