question about Medicare Part D Coverage

Options

Dear all,

I have a question about medicare prescription coverage.  From what I understand, there is a small co-pay requirement until approx. $2800 of prescription drugs have been purchased, at which point the beneficiary is in the "donut-hole" and must pay all prescription costs (with a 50% discount in 2011) until he/she has paid approx. $4500 out of pocket, at which point 95% coverage kicks, for the rest of the year. 

Here's my question:  As it stands, a relative will begin taking a very expensive drug ($6000/month) beginning tomorrow (August 1, 2011).  So by mid-September she will have already spent over $4500 and 95% coverage will kick in.  However, I'm confused about when the cycle of this 95% coverage will end. Will the 95% coverage continue until August 1, 2012  (at which point the annual cycle starts over), or will it continue until the end of the calendar year, i.e. Dec. 31st, 2011?  The former seems more fair to me, but I've read sources on the net which suggest the latter.

Your guidance is much appreciated!

 Sam

Comments

  • karen4u
    karen4u Member Posts: 194
    edited July 2011

    The coverage is per calendar year however if the drug is a chemo then it may be covered under your relative's Medicare Part B instead of the Part D Prescription plan.   

Categories