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Know Your Plan: The Coverage Gap

What is the coverage gap?

The coverage gap (sometimes called the "donut hole") is when Medicare temporarily stops paying for your prescriptions and you have to pay the entire cost yourself. The coverage gap is only estimated to affect about 8% of Medicare beneficiaries and only applies to those who have Medicare prescription drug coverage.

All Medicare drug plans are not the same. When you join a Medicare drug plan, the plan sends you information about how the coverage gap works for that plan. Read this information carefully and call your plan if you have questions.

Will the Coverage Gap affect me?

How do I get in and out of the coverage gap?

Know your Gap Status: Track Your Spending

If you still have questions about your coverage:

• Call your plan.
• Call 1-800-MEDICARE (1-800-633-4227; TTY users should call 1-877-486-2048) or visit www.medicare.gov.
• Call Social Security to find out if you qualify for extra help; call 1-800-772-1213 (TTY users should call 1-800-325-0778).
• Call your local office on aging or visit www.eldercare.gov.
• Call your State Health Insurance Assistance Program for information about Medicare and Medicaid. To find one near you call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov.