What is the “Donut Hole?”

If you aren’t familiar with the Medicare Part D “donut hole” then this post is for you. Medicare Part D, a Medicare advantage plan, provides prescription drug coverage for beneficiaries of Medicare. Basic Medicare Part D cover works like this:

  • You pay out-of-pocket monthly Part D premiums all year.
  • You pay 100% of your drug costs until you reach the $310 deductible.
  • After you reach the deductible, you pay 25% of your drug costs, and Part D pays the rest, until the total (your out-of-pocket expenses and Part D combined) reaches $2,800.
  • When the total reaches this limit you have a coverage gap called the “donut hole,” and thereafter you are responsible for the full cost of your prescriptions until the total you have paid out-of-pocket reaches the yearly limit of $4,550.
  • After this yearly spending limit is reached, you are only responsible for about 5% of the cost of your prescriptions for the year.


Needless to say, this poses a problem for many Medicare Part D beneficiaries. But at Brindle Insurance Group we can help. We provide Medicare Supplement insurance in Utah. We can help you find Medicare products to provide for all of your healthcare needs, sometimes at no cost to you. For instance, there is a program called Medicare Extra Help that helps pay your premiums and reduce the cost for your prescription drugs. This and other amendments to the Affordable Care Act help relieve the financial burden posed by Medicare gaps.


If you would like more information about Medicare Supplements or other services, please click here or call Brindle Insurance Group today at (800) 603-5099.

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