Christine Gibson, Medicare Insurance Broker

About Me

Hey there, my name is Christine, and I am your local Medicare advisor and agent. I specialize in Medicare and am devoted to helping you find the best plan that matches your specific needs and financial situation. I will take care of the daunting task of comparing plans from well-known national and local companies for you. Even better, my services are completely free! Contact me today to explore your Medicare options, and be sure to mention that you found me on Medicare Agents Hub!

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Q&A with Christine Gibson

I just started on Medicare Part D, and I'm confused about whether my new cholesterol medication counts toward my coverage gap. Can you explain?

Answer: If your new prescription medication is on the drug insurance plan's formulary (list of medications covered by the plan), it will count towards the true out of pocket maximum costs for drugs. The true maximum out of pocket costs for 2026 will be capped at $2,100. This is the most a Medicare beneficiary will pay over the course of the year towards their prescription drug costs. This amount is calculated by adding any amount paid towards a deductible, copay and coinsurance. Once the beneficiary has paid $2,100 towards their prescription medication costs, they should not have any additional costs for prescriptions covered by the Medicare Part D Insurance plan.

So I heard something about Medicare drug costs being capped at $2,000 in 2025. Is that really happening or just talk?

Answer: That is correct. The amount paid by Medicare beneficiaries towards the deductible plus any copays and coinsurance should not exceed $2,000 over the course of the year. However, only expenses for medications that are covered on the drug plan's formulary are used in the calculation. Over the counter medications and off formulary drugs do not count towards that $2,000 threshold.