Archive: If I have to pay a higher cost-sharing for my prescriptions in the Donut Hole, why don't I just stop paying my monthly Part D plan premiums?

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 remain at a 75% discount in the future.

Question: So will my drug costs always be less in the Donut Hole?

No. Depending on your Medicare Part D plan, the medications you use, and the retail price of your medications - you may find that you pay more for drug coverage when you reach the Donut Hole and you can see a few examples in our FAQ: "Will my drug cost increase when I enter the Donut Hole?"

Question: What happens when you no longer pay your plan premium?

If you do not pay your premium, you can be involuntarily disenrolled from your Medicare plan - and you may be without Part D coverage for the remainder of the year - and then you could be subject to a permanent late-enrollment penalty should you ever decide to re-join a Medicare Part D plan. So naturally, we do not recommend that you stop paying your Medicare Part D premiums.

More about the late-enrollment penalty

If you are without prescription drug coverage for more than 63 days, you will also be subject to a permanent premium penalty for each month you are without creditable prescription coverage. You can read more about the late-enrollment premium penalty on this site ("How do I calculate my Medicare Part D Late Enrollment Penalty?") Repaying unpaid premiums before re-enrollment

It is also important to note that if you stop paying your Medicare plan premiums and are dropped by your plan and then wish to enroll in a Medicare plan offered by the same insurance carrier for the following year, you will most likely be required to pay the back premiums before starting your new plan.

Using your Medicare plan also helps monitor possible medication overuse or interactions

Aside from the coverage, discount, and penalty, one positive reason for using your Medicare Part D plan is that your prescription purchases are monitored by your Part D prescription drug plan to guard against adverse drug interactions or drug overuse.

Entering the Catastrophic Coverage phase

Even if you are paying more for your medications when you enter the Donut Hole, your drug purchases will also count toward exiting the Donut Hole and entering the catastrophic coverage portion of your drug plan where you will pay only 5% of the cost of your medications.