Review your Explanation of Benefits.
month, your Medicare prescription drug plan will send you a printed Explanation
letter that will show you
how close you are to entering the Coverage Gap or Donut Hole portion of your
Medicare Part D plan.
Also notice when the price you pay for your medications changes.
Even if you do not review your Explanation of Benefits (EOB) letters, you may
notice your entry into the Donut Hole because the cost of your medications has
increased (it could be the cost of one medication or all of your medications at once). Remember that with the Donut Hole discount
, the additional Donut Hole cost may not be too great so some people already paying a high co-insurance may only notice a slight change in the price.
For example, you may have a medication that has a $300 retail cost
and you are paying a $47 co-pay for the drug (as a Tier 3 formulary drug) while in your Initial Coverage Phase
. However, once you reach the Donut Hole or Coverage Gap, you will receive a 75% discount on this brand-name drug
and pay 25% of retail or $75 instead of the $47 co-pay.
You can also calculate when you will enter the Donut Hole.
You will be able to take your plan's Initial Coverage Limit (in 2019, the Initial Coverage Limit is $3,820
) and divide by the 12 months. If your monthly retail drug costs are over this amount (not what you spend with Part D, but the actual retail value), you will enter the Donut Hole sometime during the year.
For example, if you purchase formulary medications with a retail value of over $319
month, you will enter the Donut Hole or Coverage Gap some time in 2019.
You can also use our online Donut Hole Calculator to visualize your Donut Hole exposure.
To help you visualize how far you are from the Coverage Gap, you can also try
our Donut Hole Calculator
where you enter the monthly retail value of your
medications and see a chart of your costs across the Part D coverage phases. Our Donut Hole Calculator can be found at: PDP-Planner.com
. (The Donut Hole discount calculations can be
found at the bottom of the chart.)
For more tips, please see our FAQ "How will I know if - or when I reach my Medicare Part D plan's Donut Hole or Coverage Gap?