Frequently Asked Questions about Entering the Donut Hole

Aug, 07 2024 — Your Initial Coverage Limit (ICL) is the "boundary" between your Medicare Part D plan's Initial Coverage phase (where you and your drug plan share the cost of your drug purchases) and the Coverage Gap (where you receive a fixed 75% Donut Hole discount on formulary drugs

Jul, 13 2024 — Here are 5 ways to see how close you are to your 2024 Donut Hole or Coverage Gap. Reminder about the Donut Hole "closing" . . . Although we say that the Donut Hole "closed" in 2020 since you recei . . .

May, 16 2024 — Only the retail cost of formulary drugs purchased with your Medicare Part D plan are counted toward your entry into the Coverage Gap or Donut Hole. For example, if you purchase Medication XYZ tha . . .

Oct, 23 2024 — The Initial Coverage Phase is the second part of your Medicare drug plan and follows the Initial Deductible (if your plan has a deductible). During this phase, you and your Medicare Part D plan share in the cost of your formulary drugs (for example, you pay $47 for a $500 drug).

Feb, 28 2024 — No.  Your Medicare Part D plan's Initial Deductible does not affect when you go into the Donut Hole or Coverage Gap.  However, your Initial Deductible will impact how quickly you exit the . . .

Jul, 13 2024 — 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 (also known as the Coverage Gap) -- and the cost of your pre . . .

Jun, 12 2024 — The retail cost in your Explanation of Benefits letter.  Your Medicare Part D plan's negotiated retail prescription drug prices can be (and usually are) different than the retail prices that your . . .

May, 24 2024 — 95% of your brand-name drug's retail cost is counted toward exiting the Donut Hole. If your monthly purchases of formulary medications consistently have a retail value of over $420, you will ex . . .

Jul, 13 2024 — You enter the 2024 Medicare Part D Donut Hole when the retail cost of your formulary drug purchases exceeds your plan's Initial Coverage Limit (ICL) of $5,030 and you exit the Coverage Gap or Donut Ho . . .

Jul, 13 2024 — The Medicare Part D plan's retail drug price is used to determine when you enter the Donut Hole. What you spend counts toward your total out-of-pocket costs. So entering the Donut Hole is based on the retail value of what you purchase and not what you actually spend for drugs.

Apr, 20 2024 — No, because you enter the Donut Hole based on your total retail drug expense, so buying more medications at one time will actually accumulate your total retail drug cost faster and accelerate your ent . . .

Apr, 20 2024 — You will enter into your Medicare Part D plan's Donut Hole or Coverage Gap when the total retail cost of your prescription purchases exceeds your Medicare Part D plan's Initial Coverage Limit (ICL) - . . .

Jun, 06 2020 — Yes, you should receive regular statements on your prescription spending.Medicare Part D plans send out a monthly "Explanation of Benefits" (or EOB) letters to all of their members.  The EOB lett . . .

Jul, 13 2024 — Yes.  You will enter the Donut Hole or Coverage Gap portion of your Medicare Part D plan when the total "retail cost" of your medication purchases exceeds your plan’s Initial Coverage Lim . . .

Jul, 13 2024 — Not exactly.  You will enter the Donut Hole based on the retail value of your formulary drug purchases - not just your co-payment (although a portion (or maybe all) of your co-payment will make u . . .

Jan, 11 2024 — Yes, sometime in December.  If you purchase formulary medications with a total retail value of over $420 per month you will enter the 2024 Donut Hole.  You enter the 2024 Donut Hole or Co . . .

Aug, 31 2022 — No.  If a prescription medication is not covered by your Medicare Part D plan, then the purchase price for this non-formulary drug is not counted toward your Initial Coverage Limit - and is not u . . .

Oct, 23 2024 — The Initial Coverage Phase is the second part of your Medicare drug plan and follows the Initial Deductible (if your plan has a deductible). During this phase, you and your Medicare Part D plan share in the cost of your formulary drugs (for example, you pay $47 for a $500 drug).

Aug, 07 2024 — Your Initial Coverage Limit (ICL) is the "boundary" between your Medicare Part D plan's Initial Coverage phase (where you and your drug plan share the cost of your drug purchases) and the Coverage Gap (where you receive a fixed 75% Donut Hole discount on formulary drugs

Jul, 13 2024 — 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 (also known as the Coverage Gap) -- and the cost of your pre . . .

Jul, 13 2024 — The Medicare Part D plan's retail drug price is used to determine when you enter the Donut Hole. What you spend counts toward your total out-of-pocket costs. So entering the Donut Hole is based on the retail value of what you purchase and not what you actually spend for drugs.

Jul, 13 2024 — You enter the 2024 Medicare Part D Donut Hole when the retail cost of your formulary drug purchases exceeds your plan's Initial Coverage Limit (ICL) of $5,030 and you exit the Coverage Gap or Donut Ho . . .

Jul, 13 2024 — Not exactly.  You will enter the Donut Hole based on the retail value of your formulary drug purchases - not just your co-payment (although a portion (or maybe all) of your co-payment will make u . . .

Jul, 13 2024 — Here are 5 ways to see how close you are to your 2024 Donut Hole or Coverage Gap. Reminder about the Donut Hole "closing" . . . Although we say that the Donut Hole "closed" in 2020 since you recei . . .

Jul, 13 2024 — Yes.  You will enter the Donut Hole or Coverage Gap portion of your Medicare Part D plan when the total "retail cost" of your medication purchases exceeds your plan’s Initial Coverage Lim . . .

Jun, 12 2024 — The retail cost in your Explanation of Benefits letter.  Your Medicare Part D plan's negotiated retail prescription drug prices can be (and usually are) different than the retail prices that your . . .

May, 24 2024 — 95% of your brand-name drug's retail cost is counted toward exiting the Donut Hole. If your monthly purchases of formulary medications consistently have a retail value of over $420, you will ex . . .

May, 16 2024 — Only the retail cost of formulary drugs purchased with your Medicare Part D plan are counted toward your entry into the Coverage Gap or Donut Hole. For example, if you purchase Medication XYZ tha . . .

Apr, 20 2024 — You will enter into your Medicare Part D plan's Donut Hole or Coverage Gap when the total retail cost of your prescription purchases exceeds your Medicare Part D plan's Initial Coverage Limit (ICL) - . . .

Apr, 20 2024 — No, because you enter the Donut Hole based on your total retail drug expense, so buying more medications at one time will actually accumulate your total retail drug cost faster and accelerate your ent . . .

Feb, 28 2024 — No.  Your Medicare Part D plan's Initial Deductible does not affect when you go into the Donut Hole or Coverage Gap.  However, your Initial Deductible will impact how quickly you exit the . . .

Jan, 11 2024 — Yes, sometime in December.  If you purchase formulary medications with a total retail value of over $420 per month you will enter the 2024 Donut Hole.  You enter the 2024 Donut Hole or Co . . .

Aug, 31 2022 — No.  If a prescription medication is not covered by your Medicare Part D plan, then the purchase price for this non-formulary drug is not counted toward your Initial Coverage Limit - and is not u . . .

Jun, 06 2020 — Yes, you should receive regular statements on your prescription spending.Medicare Part D plans send out a monthly "Explanation of Benefits" (or EOB) letters to all of their members.  The EOB lett . . .