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Latest Medicare News on The Donut Hole or Coverage Gap

Category: The Donut Hole or Coverage Gap


Most Viewed in Category
Understanding the 2018 Medicare Part D Coverage Gap or Donut Hole
The Donut Hole or Coverage Gap is a term used to describe a gap or pause in your Medicare Part D prescription drug plan or Medicare Advantage plan coverage where, prior to 2011, you were 100% respon . . .

Where are the Medicare Part D Plans with COMPLETE Doughnut Hole Coverage?
Question:I enrolled in a 2007 Medicare Part D plan with NO Doughnut Hole.  My Part D plan pays for both my generic and brand name medications through the entire year!  This plan will save me . . .

An explanation of the 2017 Medicare Part D Coverage Gap or Donut Hole.
The Medicare Part D Coverage Gap or Donut Hole was actually similar to a second deductible in an insurance policy where, after receiving a certain level of coverage, you were responsible for paying yo . . .

An explanation of the 2016 Medicare Part D Coverage Gap or Donut Hole.
The Medicare Part D Coverage Gap or Donut Hole is similar to a second deductible in an insurance policy where you are responsible for paying your own coverage after receiving a certain amount of insur . . .

Another Doughnut Hole Dilemma - The Pros and Cons of Filling your Prescriptions Outside of Your Part D Plan
Doughnut Hole Question: What can I do if I am approaching the doughnut hole?  Am I allowed to fill my prescriptions outside of my Part D plan?  If I did this, I would avoid the doughnut ho . . .

How much money could I possibly save with the 2016 Donut Hole Discount?
About $2,167.07 - maybe even a little more depending on your Medicare Part D plan. Your actual savings in the 2016 Donut Hole will depend on several things including: (1) How much you spent persona . . .

Extra Help in the Doughnut Hole
We designed our online PDP-Planner or Doughnut Hole Calculator to help give Medicare Part D beneficiaries an idea when they will go into the Doughnut Hole or coverage gap.However, many people are alre . . .

Probably Not a Good Idea: Cancelling Your Part D Plan Because You Hit the Doughnut Hole
Doughnut Hole Question:  I just entered the Coverage Gap last month.  Can I just drop my current Prescription Drug plan since there are no more benefits and then sign up again for 2008?  . . .

HHS Press Release: Medicare beneficiaries in donut hole will see 50-percent discount on brand name drugs in 2011
Vice President Joe Biden, the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) today announced that the nation's pharmaceutical manufacturers wil . . .

When You Purchase Meds Impacts Your Doughnut Hole Timing
Doughnut Hole Question:  What happens when we buy our prescriptions or medications in advance?  For instance, what occurs if we buy a three-month supply of medication through mail order?Answ . . .

Latest in Category
Understanding the 2019 Medicare Part D Coverage Gap or Donut Hole
The Donut Hole or Coverage Gap is a term used to describe a gap or pause in your Medicare Part D prescription drug plan or Medicare Advantage plan coverage where, prior to 2011, you were 100% respon . . .

Do I just pay the difference between the $5,000 TrOOP and my Medicare Part D plan's $3,750 Initial Coverage Limit before exiting the 2018 Donut Hole?
No.  Your $5,000 total out-of-pocket spending limit (2018 TrOOP) only includes the portion of your $3,750 Initial Coverage Limit that you actually paid. The portion paid by your Medicare Part D . . .

If I am already in the 2018 Donut Hole by May, is it cheaper to use a brand-name drug or the generic equivalent?
It depends. If you currently use Medicare Part D drugs with a retail cost of over $750 per month, you may be in the 2018 Donut Hole or Coverage Gap by mid- to late-May. While in the Donut Hole, . . .

Will I enter the 2018 Medicare Part D Coverage Gap or Donut Hole?
If the retail cost of your medications is over $313 each month, you will enter the 2018 Donut Hole or Coverage Gap. As a reminder, you will enter your Medicare Part D prescription drug plan's Donut . . .

Understanding the 2018 Medicare Part D Coverage Gap or Donut Hole
The Donut Hole or Coverage Gap is a term used to describe a gap or pause in your Medicare Part D prescription drug plan or Medicare Advantage plan coverage where, prior to 2011, you were 100% respon . . .

What will I pay for my $250 brand-name drug when I reach the Donut Hole and Catastrophic Coverage phases of my 2017 Medicare Part D drug plan?
You will pay $100 in the Donut Hole or Coverage Gap and $12.50 in the Catastrophic Coverage phase for a brand-name drug with a $250 retail value. Once the total retail value of your Medicare Part D . . .

Is the Medicare Part D Donut Hole any different if I am enrolled in a Medicare Advantage plan that includes drug coverage?
No.  If your 2018 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 . . .

In 2017, does the $4,950 out-of-pocket Donut Hole limit include the $3,700 Initial Coverage Limit so you only have to pay $1,250 ($4,950-$3,700) before leaving the Gap?
No.  Your $4,700 total out-of-pocket spending limit (2017 TrOOP) includes only the portion of your $3,700 Initial Coverage Limit that you actually paid for your medications - so, you cannot jus . . .

If I only use one brand drug that costs $347 and has a $47 co-pay, will I enter the 2017 Donut Hole?
Yes. If your retail drug costs are $347 a month you will enter your Medicare Part D plan's 2017 Coverage Gap or Donut Hole in late-October or early-November 2017. As a reminder . . . You will en . . .

Will you enter the 2017 Medicare Part D Donut Hole ... and if so, when?
You will enter your Medicare Part D plan's Donut Hole or Coverage Gap if the total retail value of your formulary prescription purchases exceeds your plan's Initial Coverage Limit, and the 2017 stan . . .






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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.