In 2018, once you and your plan spend more than $3,750 on prescription drugs, you'll move into the coverage gap.

In the coverage gap, you're responsible for a higher percentage of the cost than you were in the initial coverage stage. That's why it's called a "gap." The good news is that the government is working to close it. The percent you pay will go down every few years until the coverage gap closes in 2020.

When you're in the coverage gap, you'll usually pay:

  • 35 percent of the plan's costs for brand name drugs
  • 44 percent of the plan's costs for generic drugs

Some plans offer extra coverage for generic drugs during the coverage gap, including:

  • BCN AdvantageSM HMO-POS Prestige
  • Medicare Plus BlueSM PPO Assure
  • Prescription BlueSM Plan B

Check your plan's Evidence of Coverage to learn more.

You stay in the coverage gap until your total out-of-pocket drug spending reaches $5,000. If you get any discounts on brand-name drugs, we count it as though you paid the full price. This helps you move through the coverage gap a little faster.

Note: Not everyone has a coverage gap. If you get Extra Help paying for your prescription drugs, you don't have a coverage gap. If you get your health coverage through your employer, you might not have a coverage gap. Check your plan's Evidence of Coverage to learn more.