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2011 Medicare Donut Hole PDF Print E-mail
Thursday, 16 December 2010 22:14

Donut Hole Information

• It is the coverage gap in Medicare Part D Drug Coverage, where you are not insured for the cost of drugs

• The gap amount, or dollar threshold where you lose coverage for 2011 is $2840
- This number is calculated on retail costs of the drugs, not what you personally spend, i.e. co-pay or co-insurance.

• You exit the Donut Hole when your total out of pocket expenses reaches $4,550.
- This number is calculated in a new way beginning in 2011

• NEW in 2011 when you are in the Donut Hole you will receive discounts of 50% on Brand drugs and 7% on Generic drugs
- For exiting the donut hole, calculations include not only what you have paid toward your prescriptions, but also what specific programs have paid toward your medication costs.
- For example, since 50% of the drug is now covered, if you pay $100 and the discount is $100, the full $200 is counted towards the donut hole amount

• After you have spent $4,550 (left the donut hole) catastrophic coverage kicks in and you will have to spend $2.50 per month for generics / $6.30 per month for name brand medications or 5% of the medication's retail cost, whichever cost is higher.

• Healthcare reform plans on eliminating the Donut Hole in 2020 with small increases in the discount each year after 2011

Last Updated on Friday, 14 January 2011 19:12