Back in the 1990, everyone was obsessed with Medicare Part D’s “Donut Hole.”  Since the Affordable Care Act, the “donut hole” is less of a big deal.  This article will explain what it is and what (if anything) you should be concerned with.

What is Medicare Part D?

First lets start with the basics. Part D is America’s drug plan for Medicare eligible individuals.  Learn more about it here:  Medicare’s prescription drug program.

What is the Donut Hole?

The Donut Hole is an outdated nickname.  We now call it the “coverage gap.”  Whatever you call it, it is the period where seniors pay higher out of pocket costs for their prescription drug compared to their initial amount.  At one time most insurance providers would make you the bulk of all drug costs during the coverage gap but this has now changed.

Donut Hole “fixed” in 2020

In 2020, due to the Affordable Care Act,  The part D coverage gap was set to a fixed amount.  Basically in the coverage gap, you pay 25% and the insurance provider pays 75%.   What does this mean for you.  Well, Medicare Part D drug pricing is still confusing but you should be able to rest easy knowing that you will no longer be on the hook for the bulk of your prescription cost.

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.  We can help you find the right plan for you based on the drugs you are currently taking.  Fill out our Part D drug list here to get started.

The other option is to choose a Medicare Advantage which usually offers Rx coverage.