Have you fallen in the donut before?

If you are familiar with the donut hole, and medicare part D then don’t read on!

The donut hole begins when you have reached $2,800 in prescription drug expenditures. At this point a hole in your plan opens up leaving a coverage gap until you have reached $4,550 in yearly expenditures on prescription drugs. Once you have reached the threshold your Medicare Part D again picks up the payment. At this point you are now only responsible for 5% of your prescription drug costs. However, you are fully responsible for 100% of your drug costs once you have exceeded $2,800 in yearly drug expenses but not exceeded $4,550. Therefore, individuals over the age of 65 are responsible for $2450 of yearly prescription drug costs. Once the individual has exceeded the $4,550 limit Medicare once again picks up 95% of the costs. This gap in coverage can be very challenging for some, forcing many seniors to choose between paying for rent, groceries or medications.

Let me break this down for you -

As an example – If your drug costs $100 and you have a co-pay of $5, this means that $95 total goes towards your donut amount. So if you spend $230 a month on medication – this means that you will not get into the donut hole at all. If you spend over $230 a month but under $380 then you will be in the donut hole until your total expenditure gores above $380 a month.

That being said - if you are able to purchase prescription medication online cheaper than your co-pay or buy generics cheaply then you may avoid the donut hole altogether. If this is confusing to you, it is to us as well but you can always call us and we will help you navigate the muddy waters.