. You will enter the Donut Hole or Coverage Gap portion of your Medicare Part D
plan when the total "retail cost" of your medication purchases exceeds your plan’s
Initial Coverage Limit
This "retail cost" figure is a combination of what you pay for your medications plus the portion paid by your Medicare Part D plan.
For example, if you buy a medication at your local pharmacy that has a retail cost of $100, you will pay your plan’s co-payment or cost-sharing, maybe $30, and your plan will pay $70 or the balance of the $100 retail cost.
From this example purchase, the total retail cost of $100 is counted toward meeting your plan’s Initial Coverage Limit (ICL).
So once you have purchased medications with a retail value over your Medicare Part D plan's ICL, you enter your Medicare Part D plan’s Donut Hole.
Please remember that your Medicare Part D plan’s Initial Coverage Limit can change every year. You can click here
to see how the Initial Coverage Limit has changed since 2006.