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?

Question

Brian Moore · Accepted Answer

Figuring out how your new cholesterol medication fits into Medicare Part D’s coverage gap can be confusing—it does count toward that limit, depending on your plan’s formulary and annual drug spending. In 2025, once your total costs hit the gap, you’ll reach catastrophic coverage after $2,000 out-of-pocket, lowering your costs to zero for covered meds, and Medicare now sends a statement detailing these expenses to keep you informed. Check that statement or your plan’s formulary for a clear snapshot of your progress!

Answered by Brian Moore on March 27, 2025

Broker Licensed in OH

Answered by Brian Moore Medicare Insurance Agent

Melonie Wood · Answer

I have a special database that I am able to put a members medication in which will give us the costs .  2025 there is no coverage gap.

Clarence &quot;Mark&quot; Christiansen · Answer

There is no coverage gap or dreaded "donut hole" starting 01.01.2025. Medicare Part D members may have high out of pocket costs initially but will be protected by a $ 2,000 annual cap on
your qualifying Rx expenses. So make sure your Part D plan covers your prescription drug list.

Mitch Anderson · Answer

Each Part D plan has their own specific formulary (list of covered medications). There are also deductibles, copays, and coinsurance that factors in. It is very likely that your cholesterol medication counts towards your coverage gap but is much more complicated than yes or no. We need to know what cholesterol medication, the dosage, and plan that you are enrolled in to give a solid answer.

Answered by Mitch Anderson on March 25, 2025

Agent Licensed in MN, IA & WI

Answered by Mitch Anderson Medicare Insurance Agent

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?

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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?

Agents: Share Your Expertise

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website