Medicare Basics for Caregivers

Frequently Asked Questions

15. What is the coverage gap? How does it relate to catastrophic coverage?

Most Medicare drug plans have a coverage gap. This means that after the person and the person's drug plan have spent a certain amount of money for covered drugs, the person then has to pay all costs out-of-pocket for the drugs, up to a limit. The yearly deductible, co-insurance or co-payments, and what the person pays while in the coverage gap all count toward this out-of-pocket limit. The limit doesn't include the drug plan's premium. (Answer continues on next page.)