Hitting the Gap

This year we hit the gap a few months earlier than last year. For those of you who don't know what the gap is all about, it has to do with drug benefit Part D for those on Medicare. The gap is when the cost of drugs paid out by the insurance company exceeds a certain limit, usually $2,500. The gap spreads out until reaching about $4,500. The subscriber pays for meds at 100% during the gap, and the insurance company picks it up again in full at the outer limit of the gap.

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Since my husband is disabled, he has been on Medicare for a few years now. He has several perscriptions, one of which costs about 10 dollars per day. The rest are all available generic drugs that are relatively inexpensive. But with a drug at over $900 for a three month's supply, it breaks the bank quickly and we feel it desperately come summer.

The cost of drugs can easily take one into the gap over the course of the year. My question isn't why there is a gap, but rather, why some shots can cost in the thousands for one injection and why a bottle of pills can cost a car payment?

huttriver12's picture

Not sure what my Americano friends are...

discussing. Here in NZ we have a state organisation, Pharmac that subsidises pharm drugs. Sometimes there are drugs that are not fully subsidised like breast cancer drugs; this causes controversy and extreme concern for those involved.

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Familyfunandfaith's picture

That gap is a scary one to look into, Jellen

My wife is nearing retirement age and we are trying to find the way to make the move a bit early for her. Your post made me shudder!

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Jellen's picture

FF&F, as long as she

isn't on certain seizure or cholesterol meds or insulin, you probably won't hit the gap. Otherwize, I can't say enough good about being on Medicare. Having the supplement in addition to Parts A and the elective B, has made the difference for us. By the time the statement comes, we usually owe little or nothing, as opposed to the thousands per year when we were on private insurance.