Understanding the Medicare Donut Hole


Unless you’ve done your homework, you may not be familiar with the Medicare Part D “donut hole.” The donut hole refers to the prescription drug coverage gap in which you’ll have limited or no prescription drug coverage.

What is the donut hole?
Most Medicare Part D (Prescription Drug) plans have a coverage gap that occurs after you and your Medicare drug plan have spent a certain amount of money for coverage on prescription drugs. Once that set amount has been paid, you are responsible for all out-of-pocket costs for the drugs, up to a certain out-of-pocket limit.

This donut hole can present serious financial challenges for many Medicare beneficiaries.

What can you do about it?
There are Prescription Drug plans that offer some type of coverage while you’re in the donut hole. These plans may offer alternatives like generic coverage, or may charge a higher premium.

Once you reach the out-of-pocket max for your plan during the coverage gap, catastrophic coverage kicks in. After that, you’re only responsible for your coinsurance or copayment for the remainder of the year.

Can you get financial help?
Some people may qualify for Medicare Extra Help to cover part of the costs of their prescription drugs. The Extra Help program is a part of Medicare that’s designed to give assistance to people with limited incomes. Click here to learn more »

The donut hole is a hard concept to grasp. It’s complicated and can place a financial burden on those who are impacted. If you have questions about the prescription drug coverage gap under Medicare, please call one of our knowledgeable sales agents. They’re available to help you Monday – Friday, 6am – 5pm PT at 888-738-6356 (TTY: 711).

Posted January 24, 2017 by rocky