All About The Medicare Donut Hole

The Medicare Plans that contain the Part D (Prescription Drug) have a gap in their offering called the ‘Donut Hole’ popularly. The gap occurs between the limit of plan coverage and the maximum of out – of – pocket. As of 2018, the hole occurs from $3750 to $5000. The Donut Hole is referred to as the difference between these two numbers.

Here is the working of the Donut Hole in more detail.

  • The Part D premiums are paid month – wise throughout the coverage period.
  • The entire cost of the drugs is paid until the plans deductible is reached.
  • After touching the deductible point, the Part D pays its amount which is $3,750 as of 2018.
  • Then the donut hole is reached. However, if you and the plan combined pay less than $3,750 in drugs, there is no need to bother about the donut hole.

Before 2011, one would have had to pay the entire costs of prescription drugs inside the Donut Hole. But the discount has been increasing ever since and will continue to do so until 2020, where one would just have to pay 25% of the prescription drug cost.

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How To Exit The Donut Hole

One way to exit the donut hole as of 2018, is exceeding the costs to more than $5000. This will ensure a major coverage by the plan. Only a tiny percentage of the plan has to be paid by you for the drug costs.

Note that the $5,000 also covers the deductibles, co-payments and co-insurance.

Also, you can try out the following methods if you want to avoid getting into the donut hole:

  • If there is a discount, resort to ordering by mail
  • Whenever possible, purchase generics
  • Pay close attention to formulary associated with drugs

If you are suffering from limited monetary assistance then there is an option to ask for ‘Extra Help’. The ‘Extra Help’ is a program by the Government that provides financial aid through Social Security for the Part – D. Also, there is no need to worry about the Donut Hole in the case of ‘Extra Help’

It is vital to research about the details of the plan so that you can understand more about the Donut Hole and be more prepared in case you reach it.