01.Core Concepts

The cost-sharing provisions are complex Beneficiaries must meet an annual deductible that cannot exceed $320 in any plan After the deductible is met, beneficiaries must meet a copayment or coinsurance charge Most plans have a coverage gap, or “donut hole”, which refers to drug costs that must be paid completely out-of-pocket, after an initial amount has been covered by the plan, and until the annual out-of-pocket limit In 2015,once a beneficiary spends $4700 out-of-pocket for the year, the coverage gap ends, and catastrophic coverage, with a lower deductible, applies