What is The Medicare Donut Hole

The “Donut Hole” is a phrase used to refer to the coverage gap in your Part D Medicare prescription drug plan or the prescription drugs portion of your Medicare Advantage. Each plan has a limit on what it covers for prescription drugs each year. Unfortunately, there is no way around the Donut Hole if your necessary prescriptions fall into the coverage gap. With that, you must know what to expect so you can be prepared and not hit with any unexpected cost. Each year the dollar amounts have a chance of changing. There is an entry point and exit point of the donut hole. For 2021 the entry point is $4,130 and to exit the Donut hole the cost will have to reach $6,550. Meaning you will have to spend $2,420 while your prescription drugs are inside the donut hole. For 2022, the amounts will change and your prescription drugs and plans may be affected differently. Reaching these dollar amounts is typically based on the cost of your drugs and not the amount you pay. To figure out exactly where you fall takes some more details and I’d be happy to sit down with you and look at your specific coverage and the options you have.

Would you like some help with your Health Insurance or Medicaid options? Feel free to contact our advisor Brandon today!