Frequently Asked Questions about The Donut Hole or Coverage Gap

Your Medicare Part D prescription drug plan coverage starts again each year — and along with your new coverage, your Donut Hole or Coverage Gap begins again each plan year. For example, your . . .

Aside from the 75% Donut Hole discount that you receive on all formulary drugs purchased in the Coverage Gap, your Medicare Part D prescription drug plan may also provide additional or supplemental Do . . .

The retail cost in your Explanation of Benefits letter.  Your Medicare Part D plan's negotiated retail prescription drug cost can be (and usually is) different than the retail price that your pha . . .

The Donut Hole or Coverage Gap is the third phase of your Medicare Part D prescription drug coverage and you only reach this phase when the retail cost of your formulary drug purchases exceeds a cer . . .

If you use a Special Enrollment Period to change Medicare Part D drug plans during the year, your drug purchase history moves with you to your new Medicare plan. So if you are in the Donut Hole and move to another Part D plan, most likely you will still be in the Donut Hole.

Review your Explanation of Benefits.  Each month, your Medicare prescription drug plan will send you a printed Explanation of Benefits letter that will show you how close you are to entering . . .

No.  If you qualify for the Medicare Part D Extra Help program or Low-Income Subsidy (LIS), then you will never enter the Donut Hole or Coverage Gap -- and the cost of your prescriptions will r . . .

Yes.  Our Medicare Part D Donut Hole Calculator or PDP-Planner is designed so seniors and other Medicare beneficiaries can see how their Part D drug spending could change throughout the year and . . .

Yes.  If you use a great number of medications or one or more expensive medications, you can spend your way into, and out of the Coverage Gap or Donut Hole rather quickly. Review: When do you . . .

Only the retail cost of formulary drugs purchased with your Medicare Part D prescription drug plan count toward entering the Coverage Gap or Donut Hole.  Only your out-of-pocket drug spending (Tr . . .

If you reach the Coverage Gap, you will receive a 75% discount on all of your Medicare Part D plan's formulary drugs.  The Donut Hole Discount has increased over the past years, but should remai . . .

You can determine when (or if) you will enter your Medicare Part D Donut Hole or Coverage Gap by just dividing your Medicare Part D prescription drug plan's Initial Coverage Limit by 12 months and t . . .

Maybe.  Some Medicare Part D plans offer some additional coverage to plan members reaching the Donut Hole or Coverage Gap.  If you are using generic drugs, you will pay the plan's co-pay in . . .

Your Medicare Part D plan can be divided into four possible parts or phases and you move through these parts of your prescription drug plan depending on your prescription drug spending. The In . . .

The Donut Hole (or Coverage Gap) is the third part of your Medicare Part D plan coverage and is a term used to describe a "gap" or pause in your Medicare Part D prescription drug coverage where - pri . . .

Yes.  If your Medicare Advantage plan includes prescription drug coverage (MAPD), then the Donut Hole or Coverage Gap portion of your coverage works just like a stand-alone Medicare Part D pres . . .

If your formulary medications have a total retail cost over $370 each month, you will exceed your 2022 Medicare Part D plan's $4,430 Initial Coverage Limit and enter the Donut Hole or Coverage Gap sometime before December 31st.

If your formulary medications have a total retail cost over $370 each month, you will exceed your 2022 Medicare Part D plan's $4,430 Initial Coverage Limit and enter the Donut Hole or Coverage Gap sometime before December 31st.

Yes.  Our Medicare Part D Donut Hole Calculator or PDP-Planner is designed so seniors and other Medicare beneficiaries can see how their Part D drug spending could change throughout the year and . . .

No.  If you qualify for the Medicare Part D Extra Help program or Low-Income Subsidy (LIS), then you will never enter the Donut Hole or Coverage Gap -- and the cost of your prescriptions will r . . .

Your Medicare Part D prescription drug plan coverage starts again each year — and along with your new coverage, your Donut Hole or Coverage Gap begins again each plan year. For example, your . . .

The Donut Hole or Coverage Gap is the third phase of your Medicare Part D prescription drug coverage and you only reach this phase when the retail cost of your formulary drug purchases exceeds a cer . . .

If you use a Special Enrollment Period to change Medicare Part D drug plans during the year, your drug purchase history moves with you to your new Medicare plan. So if you are in the Donut Hole and move to another Part D plan, most likely you will still be in the Donut Hole.

Maybe.  Some Medicare Part D plans offer some additional coverage to plan members reaching the Donut Hole or Coverage Gap.  If you are using generic drugs, you will pay the plan's co-pay in . . .

Aside from the 75% Donut Hole discount that you receive on all formulary drugs purchased in the Coverage Gap, your Medicare Part D prescription drug plan may also provide additional or supplemental Do . . .

Yes.  If your Medicare Advantage plan includes prescription drug coverage (MAPD), then the Donut Hole or Coverage Gap portion of your coverage works just like a stand-alone Medicare Part D pres . . .

The Donut Hole (or Coverage Gap) is the third part of your Medicare Part D plan coverage and is a term used to describe a "gap" or pause in your Medicare Part D prescription drug coverage where - pri . . .

Review your Explanation of Benefits.  Each month, your Medicare prescription drug plan will send you a printed Explanation of Benefits letter that will show you how close you are to entering . . .

The retail cost in your Explanation of Benefits letter.  Your Medicare Part D plan's negotiated retail prescription drug cost can be (and usually is) different than the retail price that your pha . . .

If you reach the Coverage Gap, you will receive a 75% discount on all of your Medicare Part D plan's formulary drugs.  The Donut Hole Discount has increased over the past years, but should remai . . .

You can determine when (or if) you will enter your Medicare Part D Donut Hole or Coverage Gap by just dividing your Medicare Part D prescription drug plan's Initial Coverage Limit by 12 months and t . . .

Your Medicare Part D plan can be divided into four possible parts or phases and you move through these parts of your prescription drug plan depending on your prescription drug spending. The In . . .

Yes.  If you use a great number of medications or one or more expensive medications, you can spend your way into, and out of the Coverage Gap or Donut Hole rather quickly. Review: When do you . . .

Only the retail cost of formulary drugs purchased with your Medicare Part D prescription drug plan count toward entering the Coverage Gap or Donut Hole.  Only your out-of-pocket drug spending (Tr . . .