The Medicare Part D coverage gap known as the “donut hole” is the portion of Part D coverage you pay after your initial coverage period.
You enter the donut hole when your total drug costs—including what you and your plan have paid for your drugs—reaches a certain limit. In 2019, that limit is $3,820.
While in the coverage gap, you are responsible for a percentage of the cost of your drugs. This percentage has decreased each year for the past several years. In 2018, you were responsible for 35% of the cost of your brand-name drugs and 44% of the cost of your generic drugs while in the coverage gap.
Due to federal legislation, the donut hole is closing for brand-name drugs in 2019. This means that you will be responsible for 25% of the cost of your brand-name drugs in the coverage gap this year.
Although the donut hole for brand-name drugs has closed, you may still see a difference in cost between the initial coverage period and the donut hole.
For example, if a drug’s total cost is $100 and you pay your plan’s $20 copay during the initial coverage period, you will be responsible for paying $25 (25% of $100) during the coverage gap.
The donut hole will close for generic drugs in 2020, at which point you will be responsible for 25% of the cost of your generic drugs.
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