Get the free Medicare Coverage Gap Discount Program Agreement

This document outlines the agreement between the Secretary of Health and Human Services and the Manufacturer regarding Medicare coverage gap discounts, responsibilities, definitions, and compliance

How to fill out medicare coverage gap discount

How to fill out Medicare Coverage Gap Discount Program Agreement

1. Gather your personal information, including your Medicare number and contact details.
2. Obtain the Medicare Coverage Gap Discount Program Agreement form from the official Medicare website or your Medicare plan provider.
3. Carefully read the instructions provided on the form to understand the requirements.
4. Fill out the personal information section, ensuring all details are accurate and up-to-date.
5. Provide any additional required information, such as your income level or household size if applicable.
6. Review the filled-out form for any errors or omissions.
7. Sign and date the agreement to confirm that you understand and agree to the terms.
8. Submit the completed agreement according to the submission instructions provided (by mail or electronically).
9. Keep a copy of the completed agreement for your records.

Who needs Medicare Coverage Gap Discount Program Agreement?

1. Individuals who are enrolled in Medicare Part D and experience a coverage gap (donut hole) in their prescription drug coverage.
2. Seniors and disabled individuals who need assistance with high drug costs during the coverage gap.
3. Anyone eligible for Medicare who incurs high out-of-pocket expenses for medications.

People Also Ask about

What is the coverage gap discount program?

However, due to the Medicare coverage gap discount program, drug manufacturers are reducing your costs by assuming a portion of the cost on your behalf. Drug manufacturers will provide you with a 75% discount on every drug you receive during the coverage gap that is covered by your plan's formulary.

What is a specified manufacturer?

Specified Manufacturer means the manufacturer, or manufacturers, allocated to the Participant to supply Approved Vaccine pursuant to a Purchase Option, such allocation being determined in accordance with the Terms and Conditions.

What is catastrophic coverage for Medicare in 2025?

As part of a larger redesign of the structure of Part D plans included in the IRA, in 2025, beneficiaries have a $0 cost-sharing obligation during the catastrophic phase of coverage, which starts when out-of-pocket costs (deductibles, copays, and cost-sharing for covered drugs) reach $2,000.

What is the coverage gap discount?

When you're in the coverage gap (also called the “donut hole”) in your Medicare prescription drug coverage, you'll get these: A discount on covered brand-name drugs when you buy them at a pharmacy or order them through the mail. Some coverage for generic and brand-name drugs.

Is there still a donut hole in 2025?

Yes, the Medicare Part D coverage gap, often referred to as the “donut hole,” ended in 2025, leaving 3 simple phases of coverage: Deductible Phase: Beneficiaries will pay 100% of their drug costs until they meet their deductible.

What is an example of the Medicare Part D coverage gap?

Coverage Gap: You enter the coverage gap when your total drug costs — including what you and your plan have paid for your drugs — reaches a certain limit. In 2024, that limit is $5,030. While in the coverage gap, you are responsible for 25% of the cost of your drugs.

What is one of the most notable gaps in Medicare coverage?

Major Gaps in Original Medicare Prescription Drugs. Medicare Parts A and B do not include coverage for most outpatient prescription drugs. Long-Term Care. Dental, Vision, and Hearing Care. Overseas Medical Care. Routine Foot Care. Deductibles and Co-Payments. Out-of-Pocket Maximum.

For pdfFiller’s FAQs

What is Medicare Coverage Gap Discount Program Agreement?

The Medicare Coverage Gap Discount Program Agreement is a contract between the Centers for Medicare & Medicaid Services (CMS) and pharmaceutical manufacturers to provide discounts on certain medications for Medicare beneficiaries who enter the coverage gap, also known as the donut hole.

Who is required to file Medicare Coverage Gap Discount Program Agreement?

Pharmaceutical manufacturers that wish to participate in the Medicare Coverage Gap Discount Program and provide discounts to enrollees in Medicare Part D are required to file this agreement.

How to fill out Medicare Coverage Gap Discount Program Agreement?

To fill out the Medicare Coverage Gap Discount Program Agreement, manufacturers must complete the necessary forms provided by CMS, ensuring all required information is accurately filled out, and submit them within the specified time frame detailed by CMS.

What is the purpose of Medicare Coverage Gap Discount Program Agreement?

The purpose of the Medicare Coverage Gap Discount Program Agreement is to lower out-of-pocket costs for Medicare beneficiaries in the coverage gap by securing discounts on prescription medications from drug manufacturers.

What information must be reported on Medicare Coverage Gap Discount Program Agreement?

The information that must be reported on the Medicare Coverage Gap Discount Program Agreement includes details about the medications covered, the discount rates offered, the participating manufacturer’s information, and compliance with CMS requirements.