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FAQs on The Donut Hole or Coverage Gap



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Category: The Donut Hole or Coverage Gap


Most Viewed FAQs in Category
Help beyond the Donut Hole discount: Are there other ways to save money once I reach my Medicare Part D plan's Donut Hole?
Aside from the Donut Hole discount that will reduce your brand-name drug cost to 25% of retail in 2019 (and in 2020 for generics) - if you are in the Coverage Gap - and your Medicare Part D prescripti . . .

What costs count toward entering the Donut Hole or Coverage Gap?
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. So if you purchase Medication XYZ that retails . . .

I read that my negotiated retail prescription drug costs go toward meeting my Initial Coverage Limit before reaching my Medicare Part D plan's Donut Hole, but is this the normal retail drug cost or the total cost in my Explanation of Benefits letter?
The retail cost in your Explanation of Benefits letter.  Your Medicare Part D plan's negotiated retail prescription drug cost can be (and usually is) different than the retail price that your pha . . .

Does the Donut Hole or Coverage Gap restart every year on January 1st or do we stay in the Gap from the previous year?
Your Medicare Part D prescription drug plan coverage starts again each year - and along with your new coverage, your Donut Hole or Coverage Gap begins again each plan year. For example, your 2017 D . . .

If I am in the Coverage Gap and I moved outside of my plan's Service Area and switch Medicare Part D plans, will I still be in the Coverage Gap in the new plan or does it start all over?
Yes - you are still in the Donut Hole or Coverage Gap.  Your drug purchases will transfer to your new Medicare prescription drug plan when you change plans during the year and you will still be i . . .

I think that I have already spent my way through this year's Donut Hole. Is that possible?
Yes.  If you use a great number of medications or one or more expensive medications, you can spend your way into, and out of the Donut Hole rather quickly.A person enters the Donut Hole or Covera . . .

Can I avoid the Donut Hole if I buy a 90-day supply of my medications with the lower co-payment?
No.  Since your entry into the Donut Hole is based on your total retail drug expense, so buying more medications at one time will actually accumulate your total retail drug cost faster and accele . . .

What part of my drug spending counts toward my Medicare Part D prescription drug plan's Donut Hole?
Only the retail cost of formulary drugs purchased with your Medicare Part D prescription drug plan count toward entering the Coverage Gap or Donut Hole.  Only your out-of-pocket drug spending (Tr . . .

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 Donut Hole discount on any of your Medicare Part D plan's formulary drugs.  For instance, in 2018, you will not pay 100% of your drug costs, bu . . .

Will you enter the Donut Hole or Coverage Gap this year?
You can determine when (or if) you will enter your Medicare Part D Donut Hole or Coverage Gap by just dividing your Medicare Part D prescription drug plan's Initial Coverage Limit by 12 months and the . . .

Newest FAQs in Category
What is the Donut Hole or Coverage Gap?
The Donut Hole (or Doughnut Hole) is a term used to describe a gap in Medicare Part D prescription drug plan coverage or Medicare Advantage plan coverage where the Medicare plan member was (previ . . .

If I receive Medicare Part D Extra Help, will I enter the Donut Hole?
No.  If you are qualified for the Medicare Part D Extra Help program or Low-Income Subsidy (LIS), then you will never enter the Donut Hole or Coverage Gap and the cost of your prescriptions wil . . .

How will I know that I am in the Donut Hole portion of my Medicare prescription plan?
Review your Explanation of Benefits.  Each month, your Medicare prescription drug plan will send you a printed Explanation of Benefits letter that will show you how close you are to entering . . .

What costs count toward entering the Donut Hole or Coverage Gap?
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. So if you purchase Medication XYZ that retails . . .

Does the Donut Hole or Coverage Gap restart every year on January 1st or do we stay in the Gap from the previous year?
Your Medicare Part D prescription drug plan coverage starts again each year - and along with your new coverage, your Donut Hole or Coverage Gap begins again each plan year. For example, your 2017 D . . .

Do you have an online Donut Hole calculator or a way to estimate my annual Medicare Part D spending?
Yes.  Our Medicare Part D Donut Hole calculator or PDP-Planner is designed so seniors and other Medicare beneficiaries can see how their Part D drug spending could change throughout the year and . . .

I read that my negotiated retail prescription drug costs go toward meeting my Initial Coverage Limit before reaching my Medicare Part D plan's Donut Hole, but is this the normal retail drug cost or the total cost in my Explanation of Benefits letter?
The retail cost in your Explanation of Benefits letter.  Your Medicare Part D plan's negotiated retail prescription drug cost can be (and usually is) different than the retail price that your pha . . .

Help beyond the Donut Hole discount: Are there other ways to save money once I reach my Medicare Part D plan's Donut Hole?
Aside from the Donut Hole discount that will reduce your brand-name drug cost to 25% of retail in 2019 (and in 2020 for generics) - if you are in the Coverage Gap - and your Medicare Part D prescripti . . .

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 Donut Hole discount on any of your Medicare Part D plan's formulary drugs.  For instance, in 2018, you will not pay 100% of your drug costs, bu . . .

Will you enter the Donut Hole or Coverage Gap this year?
You can determine when (or if) you will enter your Medicare Part D Donut Hole or Coverage Gap by just dividing your Medicare Part D prescription drug plan's Initial Coverage Limit by 12 months and the . . .






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