Medicare Terms – D

Deductible

The amount you must pay for health care or prescriptions before Original Medicare, your Medicare Advantage Plan, your Medicare drug plan, or your other insurance begins to pay.

Demonstrations

Special projects, sometimes called “pilot programs” or “research studies,” that test improvements in Medicare coverage, payment, and quality of care. They usually operate only for a limited time, for a specific group of people, and in specific areas.

Disenroll

This means to end your membership in the plan. Disenrollment may be voluntary (your choice) or involuntary (not your choice)

Donut Hole

Also called the “coverage gap.” The donut hole is the period that begins after you and your drug plan together have spent a certain amount for covered drugs. When you’re in the donut hole, you will pay no more than 25% of the cost for your plan’s covered prescription drugs, which may be more than your usual copay or coinsurance. The donut hole ends when you have spent enough to qualify for catastrophic coverage.

Drug Tier

This is a group of drugs on a formulary. Each group or tier requires a different level of payment. You might see the groups listed as generic drugs, brand-name drugs, or preferred brand-name drugs. Higher tiers usually have higher cost-sharing. For example, a drug on Tier 2 generally will cost more than a drug on Tier 1.

Durable Medical Equipment (DME)

Certain medical equipment, like a walker, wheelchair, or hospital bed, that’s ordered by your doctor for use in the home.

During Gap

You enter this stage when your total drug costs — including what you and your plan have paid for your drugs — reach a certain limit.