Donut Hole Coverage - Part D Medicare Donut Hole

Understanding & Avoiding the Part D Medicare “Donut Hole” Coverage Gap.

Part D Medicare was enacted in 2006 to help Medicare recipients cover the ever increasing cost of their prescription medications. As much as it helps many people, one controversial aspect of the plan is the so called “donut hole”. Many enrollees in a Part D Medicare Plan are surprised when they first encounter this gap in their coverage, when they are suddenly forced to pay in full for their regular medication instead of making co payments.

What is the Part D Medicare Donut Hole?

A Part D Medicare plan provides coveerage for the cost of an enrollee’s drugs up to $2,600. If a patient exceeds that amount, he then has to pay for the next $3,463 worth of medicines out of his own pocket. By law all companies offering a Part D Medicare insurance plan must explain this coverage gap to individuals prior to enrollment, but many seniors find the language of these plans difficult to understand and fail to realize the impact that the donut hole could have on them.

Who does the Part D Coverage Gap affect Most?

Some Part D Medicare recipients are able to keep their drug costs under $2,700 all year and the coverage gap is never an issue for them. But in 2007 more than half of the people enrolled in a Part D Medicare Plan reached the coverage gap by July, spending most of the rest of the year paying for their own prescriptions in full.

Can the Donut Hole Be Avoided?

There are a number of measures Part D Medicare recipients can take that will help them avoid the coverage gap for as long as possible. One of the best ways to save a great deal of cash on medicines is to ask any physician to issue generic versions of the medicines you are prescribed. Overall, Generic drugs cost way less than the other brand names. As the FDA requires that generic drugs be as safe and effective as the brand name prescriptions they are related to there is no danger of harm being caused by this money saving switch.

Another way to lower drug costs is to ask your physician to write a prescription for a 90 day supply of your medications that you take for a chronic condition, such as diabetes or asthma, instead of the more usual 30. Most Part D Medicare insurance plans offer a substantial discount if you fill these prescriptions via their mail order pharmacies and there are even a growing number of local pharmacies willing to match the mail order prices to keep your business.

Do any Part D Medicare Plans offer “Donut Hole” Coverage?

About 25% of the available Part D Medicare plans available do offer some coverage for drugs when a patient reaches the coverage gap. These plans usually have a higher monthly premium and will often only cover generic prescriptions but such plans are worth considering if a patient takes a great many life sustaining medications.