What happens to beneficiaries once they reach the Donut Hole in prescription drug coverage?

Study for the Ohio Health Insurance Exam. Study with flashcards and multiple choice questions, each question has hints and explanations. Get ready for your exam!

In Medicare prescription drug coverage, reaching the Donut Hole, also known as the coverage gap, does not lead to a complete loss of benefits or require beneficiaries to switch plans. Instead, during this phase, beneficiaries are responsible for a higher proportion of their prescription drug costs. Initially, after a beneficiary meets their deductible and achieves a certain threshold in drug expenses, they pay a lower co-insurance or co-payment. However, upon entering the Donut Hole, they encounter higher out-of-pocket costs for their medications until they reach the out-of-pocket spending limit, which then qualifies them for catastrophic coverage. Therefore, option B accurately reflects the situation as beneficiaries transition into the Donut Hole and take on more financial responsibility for their prescriptions.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy