Medicare Part D Donut Hole Explained

Medicare Annual Election Period (AEP) / Open Enrollment (OEP) is from Oct. 15th to Dec. 7th.

The Affordable Care Act was intended to help seniors get out of what’s known as the Medicare Part D coverage gap or the “donut hole.”

In 2012, Medicare beneficiaries can look forward to more savings on generic prescription drugs while in the coverage gap phase of Medicare Part D.

Similar to Medigap Insurance, Medicare Part D is another element to the senior health insurance. For a better understanding of Medicare Part D, watch our helpful video which helps explain the coverage.

What is the Donut Hole?

Prior to 2010, the government wanted to help seniors pay for prescription drug costs. The goal was to: a.) get Medicare beneficiaries initial coverage and b.) protect any seniors with extraordinary prescription drug costs. What resulted is what’s known as the doughnut hole. Medicare beneficiaries pay a deductible and are covered for up to $2,930 in prescription drug costs. If costs exceed that number, the next $4,700 must be paid out of pocket by the beneficiary. (This period of payment is the prescription coverage gap, aka doughnut hole.) After that, catastrophic coverage kicks in and Medicare will begin paying a percentage of the senior’s prescription drug expenses again.

Medicare Part D Coverage

When the Affordable Care Act was put into action, the government aimed to help seniors that fell into this expensive coverage gap. Now, while in the doughnut hole, Medicare beneficiaries get a 50% discount on brand name drugs and 14% (as of 2012) on generic prescription drugs.

Medicare Part D Prescription Drug Coverage with savings

Remember, there is less than a week left for Medicare Open Enrollment. If you’d like to speak with a Medicare and Medicare Supplement Insurance specialist who can answer questions about Medicare Part D coverage or any other senior health insurance options, please call us at (877)-413-1556 or send us your information with the Medigap quote form below.