What Is The Medicare Part D Doughnut Hole?

What is the Medicare part D Doughnut Hole? Does every plan have a gap? How much extra will I pay? When will the gap end and I do have coverage again?

What is the Medicare part D Doughnut Hole? The gap in coverage that occurs in the supplemental prescription plan is often referred to as the “doughnut hole”. This gap in coverage usually occurs when a person hits the $2250.00 dollar mark in prescription costs. Once you hit this mark you will be responsible for the full cost of your medication until the person covered reaches $3600.00 in out of pocket expenses for prescription costs. Once the out of pocket amount has been reached the supplemental insurance will kick back in and cover prescriptions again with a minimal co-pay.

Will co-payment amounts apply to the gap?

Co-pay amounts that were made during the initial coverage period will count toward the $3600.00 requirement. This is an average figure and some plans may have a lower threshold and some may have a higher amount required before insurance coverage resumes.

What is the Medicare part D Doughnut Hole in relation to other coverage?

The Medicare part D Doughnut Hole only relates to prescription coverage. This does not in any way relate to care received from physicians or hospitals. Part D is supplemental insurance that helps cover the costs of prescriptions.

Is this a one time gap?

The Medicare part D doughnut hole is an annual figure. Each year the insured is set back to zero and the amount of coverage is restarted. Once you hit the initial $2250.00 mark you will again be required to reach the $3600.00 in payments again before you are re-insured. If there are changes in the requirements you will be notified by your carrier in the beginning of the year.

Related posts

1. What Is The Medicare Part D Doughnut Hole?
2. What Is The Gap In Medicare Part D?
3. What Does Health Care Reform Means for Medicare Drug Coverage?
4. Why Is Humana A Good Choice For Medicare Part D?
5. Will Medicare Supplemental Pay For My Prescription Drugs?

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