Five Things To Know About the Medicare Donut Hole

The gap in coverage faced my many is commonly referred to as the “Medicare Donut Hole”.

part-d-donut-holeIn recent years, options for seniors who are Medicare beneficiaries can be quite confusing, especially when it comes to supplemental coverage such as Part D, which is designed to cover prescription drugs costs.  Here is a list of five things you and your family should consider when choosing the most effective ways to close the Medicare Donut Hole.

1. In 2006, the legislation passed by Congress which created the Medicare drug benefit went into effect. However, many seniors have already been forced to pay out-of-pocket expenses and incur financial hardships due to the leeway afforded insurance carriers that offer Part D prescription drug coverage. The Medicare Donut Hole gap exists when beneficiaries have exceeded their chosen supplemental plan’s standard limit for prescription drug spending, but have yet to qualify for catastrophic coverage. For many, that gap in coverage has caused significant financial strain, especially for the thousands of seniors on a fixed monthly income.

2. Not all Prescription Drug Plans (PDPs) are the same. Some PDPs cover generic drugs within the gap, while others do not. Those that do often charge a more expensive monthly premium. Which, of course, is another good reminder to read the fine print for any plan you are considering.

3. To calculate personal drug costs, specifics about the prescription drugs you are currently taking. The calculator will generate a report for you based on your location and prescription list that can save you money and help close the gap.

4. As part of the Affordable Care Act, the Department of Health and Human Services began issuing $250 rebate checks to Medicare beneficiaries in June 2010, in an effort to offset some of the cost occurred by seniors and their families who fell into the Medicare Donut Hole coverage cap. In 2011, additional concessions to close the hole will also begin to take effect. These include a 50% reduction in the cost of brand-name prescription drugs, which will be financed by drug companies as part of a deal made with the White House in an effort to overhaul the drug industry.

5. Unfortunately, some rebate check recipients have fallen prey to scammers who contact beneficiaries via the telephone and ask for additional personal information. Keep in mind, you are not required to give any information to a third party to receive a check. If you or a loved one think you may have come in contact with a scammer, suspicious calls can be reported directly to Medicare by calling 1-800-633-4227.

By 2020, the government hopes to close the gap in prescription drug coverage completely, changing the Medicare Donut Hole to a filled donut…Boston Cream perhaps. For more information regarding the Affordable Care Act’s benefits (current and future) for seniors, visit for all the latest news.