Which of the following statements is NOT true about the Coverage Gap?

The statement indicating that only some members experience the Coverage Gap is accurate because the Coverage Gap, also known as the "donut hole," is specifically related to Medicare Part D prescription drug coverage. Not all members will reach this phase; it applies only to those who exceed their initial coverage limit for drug spend.

The Coverage Gap affects patients with high prescription drug costs, meaning that members who do not spend enough on their medications will fall into the initial coverage phase, where they pay standard copays or coinsurance, and won’t hit the threshold that triggers the gap. Therefore, the correct assertion communicates that not everyone will enter this stage, highlighting its relevance to only certain individuals based on their prescription needs and spending.

Additionally, the other statements accurately describe the nature of the Coverage Gap: it does indeed affect prescription drug coverage, it occurs after a certain spending limit has been reached, and it is not universal but conditional, depending on each member's formulary and medication expenses.