What is the Doughnut Hole?

The Coverage Gap is Sometimes Referred to as the Doughnut Hole

Most Medicare drug plans have a coverage gap or doughnut hole. After you and your health plan have spent a certain amount of money for covered drugs, you have to pay all costs for your drugs during this coverage gap. This also means that you would then be in the doughnut hole. You must also continue to pay the monthly premium while you are in the coverage gap.

Each state offers at least one plan that provides some type of coverage during the coverage gap or doughnut hole. However, plans with gap coverage may charge a higher monthly premium. Some plans may only offer generic drug coverage during the gap. You can use our free Part D Comparison Tool to see which plans might cover the drugs you use.

Is there anything I can do to delay reaching the coverage gap?

There are a number of things you can do to help reduce your drug costs, they include:

Switching to lower cost drugs. Talk to your doctor about using generic and/or over-the-counter (OTC) drugs. Many work as well as the higher cost prescriptions. It can help you save hundreds of dollars a year and can be just enough to keep you out of the coverage gap.
Take advantage of mail-order programs. They can save you many dollars a year on medication used long term (90 days or longer).
Always use your Medicare drug plan card. When you use your drug plan you get discounted rates on the drugs you buy and any money spent on drugs is automatically counted towards your deductibles.
Look for programs that offer assistance. Programs, such as the National Patient Advocate Foundation or the National Organization for Rare Disorders, may have programs that can help with your drug costs. Comprehensive information on federal, state and private assistance programs in your area are available at www.benefitscheckup.org

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