Donut Hole

One of the confusing parts to many people is The Donut Hole:  

Prescription drug coverage consists of multiple stages. The first phase starts on your prescription drug plan’s effective date – often January 1.

This primary phase involves reaching your deductible – up to $480. You are responsible for paying 100% of this cost.

After meeting the deductible, you enter the initial coverage phase. During this phase, you are only responsible for copayments. After the cost of drugs reaches $4,430, you fall into the donut hole.

While in the donut hole, you will need to pay 25% of the cost for generic and brand-name drugs until what you pay out-of-pocket reaches $7,050. The final phase, catastrophic coverage, kicks in when you leave the gap.

You are responsible for just $3.95 for generic medications and $9.85 or 5% of your drug costs in the catastrophic coverage phase, whichever costs more. You will remain in this phase until the end of the calendar year. The monthly statements you obtain from your plan provider should show your current status regarding the donut hole.I always welcome any questions,  Feel free to contact me.