Key Medicare Parts A & B Coverage Gaps

Medicare Supplements

Plan F’s benefits cover all deductibles and coinsurances above.

Plan G is the same as Plan F except its does not pay the Part B Deductible (see table above).

Plan N is similar to Plan G – has copays for doctor visits ($20) and ER visits ($50) – additional costs if non-participating providers are used.

The deductible for High Deductible Plans F & G is $2800 (2023: $2700) (not to be confused with standard Plan F & G)

Part D – Overview

Medicare home page https://www.medicare.gov/

Part D – A Simplified Explanation

Below is Dee-Signed’s simplified explanation of Medicare Part D Benefits 2024 (Not a legal interpretation)

First, a definition
True Out-of-Pocket (TrOOP) is a term used to refer to all the monies you have spent (as well as some bonus credits from name brand drugs taken in the Coverage Gap “donut hole”) towards the $8000 limit where you leave the Coverage Gap “donut hole” and enter Catastrophic Coverage.

In a nutshell: Your portion of the $8,000 TrOOP required to reach catastrophic coverage, is reduced by 75% of the cost of brand-name drugs purchased while in the “Donut Hole”.

Annually, there are four “phases” of Medicare Part D, each handles prescription costs differently.

Phase 1: Deductible
You pay $0 to $505 depending on plan, amount you pay added to TrOOP.

Phase 2: Initial Coverage
You pay copays until you and insurance have paid $5,030 for the year. Your copays are added to TrOOP.

Phase 3: Coverage Gap (Donut Hole)
Generic Drugs: You pay ~25% – that amount is added to TrOOP
Name Brand Drugs: You pay ~25% – that amount is added to TrOOP. ADDITIONALLY ~75% of the drugs’ costs are credited to TrOOP.

You exit the Coverage Gap when your TrOOP equals $8000 via monies you’ve paid this calendar year and the special ~75% brand name donut hole drug credits mentioned above.

Phase 4: Catastrophic Coverage (After Donut Hole)

  • 100% coverage