Medicare Part D - Closing The Donut Hole!


I read a Medicare Rights Center Blog post as well as other articles from different sources. So I thought I’d share this relevant information I found about closing the "Donut Hole!” 
Note: For those of you that may be unfamiliar with the term “Donut Hole,” it is also known as a “Coverage Gap" for Part D prescription drug plans.

So you may be thinking what does that mean to me. In 2020, the donut hole has closed. Even with the Donut Hole closing, that still does not mean you won’t have to pay for medications once they get to this drug payment stage.

Here is a little background:
When Part D first started in 2006, the Part D drug plan had a gap in coverage. Drug plans did not pay anything toward the cost of drugs in the donut hole so beneficiaries were stuck with the tab for the entire cost. 

"When Congress expanded Medicare to cover prescription drugs by adding Part D, they built in a coverage gap that made drug coverage disappear when people reached a certain spending level, then reappear when they hit another threshold. This donut hole left many people with Medicare struggling to afford their medications for at least part of the year.”1

However in 2012, the Affordable Care Act made changes and implemented discounts for the Donut Hole which reduced the impact to Part D plan members. Each year, those discounts slowly reduced the out of pocket percentages that members were required to pay during the Donut Hole. After 2020, drug plan members will no longer face an increased percentage of the cost for medications during the Donut Hole. They will pay 25% of the cost for any prescribed medication from the time they meet the deductible until reaching the out-of-pocket spending limit. 


Click on web link below to read the entire Medicare Rights Center Blog post:

https://blog.medicarerights.org/closing-donut-hole-means-matters/


1. Source: Medicare Rights Center Blog
https://blog.medicarerights.org/closing-donut-hole-means-matters/

2. Source: 65 Incorporated 
https://www.65incorporated.com/topics/medicare-part-d-prescription-drug-plans/medicare-donut-hole-closing/

3. Additional Source: KFF
https://www.kff.org/medicare/issue-brief/closing-the-medicare-part-d-coverage-gap-trends-recent-changes-and-whats-ahead/

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