The Medicare Donut Hole

By April Lujan, Health Insurance Store, 505-200-0069

I recently got a phone call from Phil in Albuquerque, he was concerned because when he went to the pharmacy to pick up his prescriptions the cost double and even tripled on some of his drugs. I explained, unfortunately you have hit the donut hole.

The term donut hole explains the gap in prescription drug coverage in part D of Medicare, when the cost of your prescriptions in tiers 3-5 will jump to 40% or 51% dependent on the drug tier. In other words, when the total cost of your prescriptions exceeds $3700.00 the consumer on Medicare part D must pay 40% of the cost of Brand Name drugs on tier 3 & 4 and must pay 51% of the cost of Generic drugs on Tiers 3,4, and 5.

Many people are not told about the donut hole and are often shocked and not able to pay the out of pocket costs required during the coverage gap. Fortunately, there is light at the end of the tunnel, once the total cost of the prescriptions hit $4950.00, you have hit catastrophic coverage. This means, the cost of your prescriptions are now only 5% of the cost for generics or a $3.30 copay, whichever is greater and a $8.25 copay for all other drugs.

I have found that most consumers are not told about the coverage gap A.K.A the donut hole and that this can really devastate their pocket books not to mentions their health. If the donut hole confuses you or if you are worried that you may hit this donut hole, please call me and my friendly staff and we will be happy to explain. You can call us at 505-200-0069 or email me at April@getyourbestplan.com