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How does the Coverage Gap or “Doughnut Hole” Subsidy Work?
Once you reach $2,700 in yearly drug costs, you will enter the coverage gap or “doughnut hole.” Maryland SPDAP members, who are enrolled in one of the 22 Medicare Part D subsidy plan options (click here for participating plans), are eligible to receive a subsidy of up to $1,200 per year to reduce their costs while in the coverage gap. No additional membership card is required. The subsidy will be provided by using your existing Medicare plan ID card and identification number.
You will still be required to pay a drug copay or coinsurance while you are receiving the state coverage gaps subsidy. The copay or coinsurance may be different from those charged by your drug plan before you reached the “doughnut hole”.
If you are a new member to SPDAP and were already in the “doughnut hole,” when you enrolled, your subsidy will begin on your approval date in SPDAP.
Can I change to a “Doughnut Hole” Plan in Mid-Year, if I’m nearing the Coverage Gap?
As a SPDAP participant, you are permitted to change plans one additional time during the year. If you are concerned that you will have drug expenses exceeding $2,700 and possibly have costs in the coverage gap phase, then you should consider changing your enrollment to one of the Medicare Part D prescription drug plans that have agreed to offer the Maryland coverage gap subsidy (click here for participating plans). To change your current Medicare Part D plan, contact the plan in which you wish to enroll. Once you’ve been accepted in that plan, your information will be given to Medicare, and Medicare will inform SPDAP of your new plan. This will take a few months to finalize.
If you are not enrolled in Maryland SPDAP, you can download an application from the “How to Apply” menu on this website, or contact the SPDAP Call Center toll free at 1-800-551-5995, Monday through Friday, from 8:00 am to 5:00 pm.
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