How does the Coverage Gap or “Doughnut Hole” Subsidy Work?

As a Medicare Part D recipient you are responsible for 100% of your prescription drug costs while in the coverage gap, less applicable Federal Drug Discounts and any supplemental coverage offered by your plan.  If your total drug costs exceed $3,310 before the end of the year, you may be eligible for this new Coverage Gap Subsidy.  The maximum benefit per SPDAP member for 2016 is $600.00.

To take advantage of this Coverage Gap Subsidy you will need to provide us with your December 2016 Monthly Prescription Drug Summary Statement provided by your Medicare Part-D plan.  Your December 2016 Statement will indicate your total drug costs for the 2016 plan year.

  • If you do not have drug costs that exceed the initial coverage limit of $3,310, you do not need to submit your Benefit Summary Statement. You are not entitled to the coverage gap benefit. 
  • If the total drug costs are above the initial coverage limit $3,310, please submit your December 2016 Monthly Prescription Drug Summary Statement for our review.

Members who receive a partial Federal Low Income Subsidy (LIS), or Extra Help, are not eligible to receive the coverage gap subsidy.  However, you may be entitled if your LIS became effective or ended in 2016.  If you began receiving partial LIS after Jan. 1, 2016, please provide us with your Monthly Prescription Drug Summary Statement for the month in which your partial LIS became effective.  If your partial LIS ended on Jan. 31, 2016 through Nov. 30, 2016, please provide us with your December 2016 Monthly Prescription Drug Summary Statement.

We must receive your 2016 Monthly Prescription Drug Summary Statement by May 31, 2017 to be eligible for the 2016 Coverage Gap Subsidy benefit.

If we find that you are eligible for any part of the Coverage Gap Subsidy benefit, a check will be issued and mailed to you directly from the Senior Prescription Drug Assistance Program.

If you have any questions about the Senior Prescription Drug Assistance Program Coverage Gap Subsidy benefit, or any other SPDAP questions, please call us at 1-800-551-5995; Mon-Fri, 8:00am-5:00pm EST

If you are not enrolled in Maryland SPDAP, you can download an application from the “How to Apply” menu on this website.