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How can an independent co-pay foundation help you with Medicare Part D Coverage?

Depending on your total drug costs, your Medicare Part D coverage changes. At each point, however, you will need to pay for part of your medications. If you cannot afford to pay, an independent co-pay foundation may help you cover your costs.

Click on the Medicare Part D coverage phases in the buttons below the chart to learn more about how Medicare Part D covers your medication. Then click on the "Show Co-pay Foundation Assistance" button to see how an independent co-pay foundation can help you.


Show Standard Payments   Show Co-pay Foundation Assistance  

 
Hypothetical Example:

You pay: $0

You pay: $310

You pay: $0

You pay: up to $945 to reach the coverage gap (donut hole)

You pay: $0

You have paid: $945
Now you pay: Up to $1,712 more to get through the coverage gap (donut hole)

You pay: $0

You have paid $2,657 and now are in Catastrophic coverage
Now you pay: 5% co-insurance

Click here to see independent co-pay foundations that may be able to help.

Source: Center for Medicare & Medicaid Services.

Medication Costs Summary

You need to pay the first $310 of your drug costs yourself, even if you have Medicare Part D coverage.

If you cannot afford to pay, an independent co-pay foundation might be able to help. Click here to see independent
co-pay foundations that may be able to help.

You need to pay the first $310 of your drug costs yourself, even if you have Medicare Part D coverage.

If you cannot afford to pay, an independent co-pay foundation might be able to help. Click here to see independent
co-pay foundations that may be able to help.

When your total drug costs reach between $310 and $2,850, Medicare coverage begins. Medicare will cover most of your drug costs, but not all of them. You will need to pay up to $945 yourself.

If you cannot afford to pay, an independent co-pay foundation might be able to help. Click here to see independent
co-pay foundations that may be able to help.

When your total drug costs reach between $310 and $2,850, Medicare coverage begins. Medicare will cover most of your drug costs, but not all of them. You will need to pay up to $945 yourself.

If you cannot afford to pay, an independent co-pay foundation might be able to help. Click here to see independent
co-pay foundations that may be able to help.

When your total drug costs are between $2,850 and $6,455, you reach the Medicare Part D coverage gap, or "donut hole." This means Medicare stops covering your drug costs. When you reach the donut hole, you need to pay for half of your drug costs. The drug company automatically covers the other half. At this point, you will need to pay up to $2,657 yourself.

If you cannot afford to pay, an independent co-pay foundation might be able to help. Click here to see independent
co-pay foundations that may be able to help.

When your total drug costs are between $2,850 and $6,455, you reach the Medicare Part D coverage gap, or "donut hole." This means Medicare stops covering your drug costs. When you reach the donut hole, you need to pay for half of your drug costs. The drug company automatically covers the other half. At this point, you will need to pay up to $2,657 yourself.

If you cannot afford to pay, an independent co-pay foundation might be able to help. Click here to see independent
co-pay foundations that may be able to help.

When your total drug costs are over $6,455, Medicare covers most of your drug costs again. You now pay $6.35 per prescription or 5% co-insurance, whichever is greater. Medicare will cover the rest.

If you cannot afford to pay, an independent co-pay foundation might be able to help. Click here to see independent
co-pay foundations that may be able to help.

When your total drug costs are over $6,455, Medicare covers most of your drug costs again. You now pay $6.35 per prescription or 5% co-insurance, whichever is greater. Medicare will cover the rest.

If you cannot afford to pay, an independent co-pay foundation might be able to help. Click here to see independent
co-pay foundations that may be able to help.

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Assistance:
Help paying for medication or other healthcare-related expenses.
Commercial insurance:
A service where a company pays for a person's healthcare-related expenses, including medications and treatments. Commercial insurance differs from Medicare and Medicaid in that a private company runs it.
Coverage:
The healthcare-related expenses that an insurance plan will pay for.
Coverage:
The healthcare-related expenses that an insurance plan will pay for.
Co-pay/Co-payment/Co-insurance:
An insurance plan may pay for most of a medication or treatment, but sometimes the person with insurance will still need to pay a certain amount. When the insurer's part is a fixed amount, it is called a co-pay or co-payment. When the insurer's part is based on a percentage of the cost, it is called co-insurance.
Foundation, Independent foundation:
A non-profit organization that donates funds and support to other groups, or provides funding for its own charitable purposes. Some foundations can help people pay for their medications.
Health insurance:
A service where a company or the government pays for a person's healthcare-related expenses, including medications and treatments.
Medicaid:
A US-government program that helps pay medical costs for people who meet certain low-income limits.
Medicare:
A US-government program that helps pay medical costs for people who meet certain low-income limits.
Out-of-pocket expense:
The money a person with insurance has to pay for a medication or treatment. This can include deductibles, co-pays, co-insurance, or other expenses related to medical care which are not covered by insurance.
Support:
Help paying for medication or other healthcare-related expenses.
Underinsured:
People who have health insurance but may have difficulty paying for the co-payments, co-insurance, or deductibles related to their medications and treatments.
Uninsured:
People who do not have health insurance.