info-05-2010

STEP 1: SELECT YOUR PLAN

WANT TO AVOID THE MEDICARE DRUG COVERAGE "DOUGHNUT HOLE"?If you have Medicare Part D, you may be at risk of falling into the coverage gap, or "doughnut hole." Follow this four-step tool and save money!

This is how the Doughnut-Hole Calculator works:

Gather your medications and drug plan card before you start. Then enter in your zip code and select your plan from the list.
Enter the name of each of your drugs, its dosage, and how often you take it.
View a chart for the year to see if you’re likely to hit the doughnut hole.
Explore a list of alternative drugs that are therapeutically similar to those you take now but could reduce your expenses and stretch your coverage. Print out the results to take to your doctor.

Start Here

What IS the Doughnut Hole?
The “doughnut hole” refers to a gap in prescription drug coverage under Medicare Part D. In 2011, once you reach $2,840 in prescription drug costs (which include both your share of covered drugs and the amount paid by your insurance,) you will be in the coverage gap. During this gap in coverage, if you are not receiving Extra Help (the low-income subsidy), you pay the full costs for prescription drugs. When your total out-of-pocket costs reach $4,550, you qualify for catastrophic coverage.” At that point, you are responsible for only 5% of your prescription drug costs for the rest of the year.
Starting in 2011, you will get a 50% discount on brand-name drugs and a 7% discount on generic prescription drugs while you are in the coverage gap. Because of the Affordable Health Care Act of 2010, the coverage gap/ “Doughnut Hole” will gradually narrow until it disappears in 2020.
If you want to see whether you are eligible for the Medicare Extra Help Program, check out Benefits Quicklink.
To share your experiences with the doughnut hole calculator and ask questions, visit the Medicare Part D online community group.
Find out more about how the new health care law helps people who fall into the doughnut hole this year by checking out this fact sheet.
Learn more about the doughnut hole at this AARP Bulletin guide on Medicare Prescription Drug Coverage.