Coverage Gap (Medicare Prescription Drug Coverage)
Medicare Glossary
Also called Donut Hole, the coverage gap is a period in which you will be responsible for paying higher cost sharing for prescription drugs until you qualify for catastrophic coverage. The coverage gap starts when you and your plan have both paid a set dollar amount for prescription drugs during the year.
Have Questions About Medicare?
Speak with an agent who can help you understand your coverage options - no cost, no obligation.
This content is for educational purposes only and does not constitute a recommendation of any specific Medicare plan. Benefits, costs, and availability vary by plan and location. For complete information about your Medicare options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY: 1-877-486-2048, available 24 hours a day, 7 days a week.
Related Articles
Medicare and Organ Transplants: Coverage and Anti-Rejection Drugs
Medicare covers transplants at approved facilities and the immunosuppressive drugs that follow — but the 36-month rule for kidney patients has a separate benefit attached.
Read MoreMedicare Coverage for Braces, Prosthetics, and Orthotics
Part B covers artificial limbs, leg and back braces, and therapeutic shoes for diabetes — but each sits in a different benefit category with its own rules.
Read MorePart B vs Part D Drugs: Which Part of Medicare Pays?
Infused drugs bill to Medicare Part B, pharmacy drugs to Part D — and the $2,100 out-of-pocket cap only applies to one of them. How to tell which part pays.
Read More