Archive: If I am in the Donut Hole, will my coverage start over on January 1st or will I remain in the Coverage Gap?

On January 1st, your Medicare Part D plan will start over - and you will no longer be in the Coverage Gap.

If your Medicare Part D plan has an initial deductible, you will need to pay the initial deductible before reaching the initial coverage phase (although some Medicare plans have provided coverage of low-costing Tier 1 and Tier 2 drugs while in the initial deductible).

If your Medicare Part D plan does not have an initial deductible, you will be start your plan year in your Medicare Part D plan's initial coverage phase.

Once you reach the Initial Coverage Limit (for example, $4,660 in 2023 and $5,030 in 2024), you will go into the Coverage Gap or Donut Hole and receive the Donut Hole discount.

Depending on your medication use, it is possible that you will reach your out-of-pocket limit (for example, $7,400 in 2023 and $8,000 in 2024) and continue into the Catastrophic Coverage portion of your Medicare Part D plan coverage. In 2024, you will have no additional cost-sharing for formulary drugs once reaching Catastrophic Coverage.

You can also use our online Donut Hole Calculator to visualize your Donut Hole exposure.

To help you visualize how far you are from the Coverage Gap, you can also try our Donut Hole Calculator where you enter the monthly retail value of your medications and see a chart of your costs across the Part D coverage phases. Our Donut Hole Calculator can be found at: PDP-Planner.com. (The Donut Hole discount calculations can be found at the bottom of the chart.)

For more tips, please see our FAQ "How will I know if - or when I reach my Medicare Part D plan's Donut Hole or Coverage Gap?"