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What is the Donut Hole in 2019?

Medicare's Part D Donut Hole Explained

by Ray Wilson+ on Jun 07, 2019

Medicare Part D’s “Donut Hole” can require significant costs for those 65 and over. However, the percentage you pay for during the Donut Hole each year has been decreasing each year.

This article was last updated on June 7th 2019.

What is Medicare Part D?

Part D is Medicare’s prescription drug program. 

What is the Donut Hole?

The Donut Hole is a “coverage “gap where seniors pay higher out of pocket costs for their prescription drug compared to their initial amount. In 2019 the Donut Hole will work this way:

  • The Donut Hole (your increased cost share) starts after spending $3,820 toward drugs.
  • You pay 25% of brand-name costs
  • You pay 37% of generic costs
  • The Donut Hole closes after you have spent $5,100 towards drugs.
  • Once you satisfied the Donut Hole, you pay only 5% for drug costs for the rest of the year.

Donut Hole Closes by 2020

Each year the amount patents have to pay under the Donut Hole gets smaller.  After 2020 it gets fixed at 25% (you pay) and 75% (the insurance company pays). 

Ways to Get Part D

If you have Original Medicare or the Original Medicare and Medigap combo,  prescriptions aren’t covered so you’ll want to enroll in a Part D drug plan. The other option is to choose a Medicare Advantage which usually offers Rx coverage.

During Medicare’s Open Enrollment (Oct 15 -Dec 7) you can switch or enroll in Medicare Part D.  You may still be able to change your current plan outside of Open Enrollment if you switch to a 5-star rated prescription drug plan. For further questions about drug plan coverage gaps call the number above or contact Senior65.

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PLEASE NOTE: We cannot comment on specific Medicare claims. Contact Medicare directly if you are trying to see if your issue is covered.




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