Is there a difference between 2013 Medicare Part D plans with Donut Hole coverage and the Donut Hole discount?

Yes. The Donut Hole discount is available to all Members of Medicare Part D prescription drug plans that reach their plan’s Coverage Gap. The 2013 Donut Hole discount is applied to all of your formulary drugs and you receive a 52.5% discount on your brand-name drugs and a 21% discount on generic drugs purchased while you are in the Donut Hole.

So even if your Medicare Part D plan coverage states that the plan has “No Donut Hole Coverage”, you still receive the Donut Hole discount – but no additional Donut Hole coverage from your Medicare Part D plan.

However, some 2013 Medicare Part D plans also offer coverage on your medications when you enter the Donut Hole - just as if you were still in your Initial Coverage phase.

So while in the Donut Hole, you would pay either a co-payment (flat fee) or co-insurance (percentage) of you drug costs depending on your medications drug coverage tier, and you will receive the Donut Hole discount on top of your plan’s Donut Hole coverage.

For example, if you purchase a $100 brand-name drug in the Donut Hole, and your plan covers this drug with a $10 co-payment while in the Gap, then you will get a 52.5% Donut Hole discount on that $10 copay for a total cost of $4.75.

Unfortunately, no 2013 Medicare Part D plan offers complete Donut Hole coverage on all formulary drugs. Instead, 2013 Donut Hole coverage is typically available only for a small number of formulary drugs.

You can click here to see how Donut Hole coverage varies between stand-alone Medicare Part D plans in 2013.

Please note that if you receive financial Extra Help with your Medicare Part D plan, you do not have a Donut Hole in your Medicare Part D coverage, so you never need to consider the Donut Hole discount.