In Medicare Part D, there is a coverage gap that is known as the “donut hole.” This is when people have reached a certain spending level and their drug coverage would disappear, only to reappear when they hit another level of spending. Meaning, people will have to pay a higher percentage of out-of-pocket funds for medication they are required to take. The “donut hole” was created to get the seniors’ help in keeping the cost of prescription drugs low by encouraging people to request generic drugs instead. Some seniors required the brand name drugs that they knew would work. This gap made it hard for many people in Part D to afford their medication for a part of the year. Although the gap is common, not e veryone will reach that level of spending that requires them to go down the "donut hole". You are more likely to hit that point if your doctors prescribe you a lot of prescription drugs.
Eventually, Congress made changes to help people who happened to be in the "donut hole". The Affordable Care Act made it mandatory that drug manufacturers give high discounts to people who were in the gap. This helped towards the eventual goal of closing the gap for 2020. The gap, however, will close for brand-name drugs at the end of 2018. This will make it so the plans will keep paying 75% of expenses on brand-name drugs until a person hits an outrageous limit. The gap is closed by making drug manufacturers cover more of the costs for those enrolled in Medicare part D when they reach the "donut hole".
What does this mean to you? Will you reach the “donut hole”? We are here to answer all your questions. Let us help you Take the Mystery out of Medicare!