How the Medicare Part D Coverage Gap (“Donut Hole”) Works (infographic)

 

The Medicare Part D coverage gap, also known as the “donut hole,” is a temporary limit on what your Medicare Part D Prescription Drug Plan pays for covered prescription drugs. While in the coverage gap, you’ll pay a higher share of out-of-pocket costs for these medications.

You enter the coverage gap once you and your Medicare Part D Prescription Drug Plan have spent a certain combined amount on covered drugs. (In 2016, you’re in the coverage gap once you and your drug plan have spent $3,310, including the deductible.) Every Medicare Prescription Drug Plan and Medicare Advantage Prescription Drug plan has this spending limit, which may change from year to year.

Not everyone reaches the coverage gap, but you’re more likely to do so if you take a lot of prescription drugs, or your copayments and coinsurance costs are higher.

Take a look at our infographic showing how the Medicare Part D coverage gap works now and in the coming years.

medicare-donut-hole-04152016

 

Some Medicare Advantage Prescription Drug plans and Medicare Prescription Drug Plans offer additional coverage if you enter the coverage gap. To learn about your Medicare Part D options, feel free to contact one of eHealth’s licensed insurance agents at the telephone number listed below.

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To learn about Medicare plans you may be eligible for, you can:

  • Contact the Medicare plan directly.
  • Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
  • Contact a licensed insurance agency such as Medicare Consumer Guide’s parent company, eHealth.
    • Call eHealth's licensed insurance agents at 888-391-2659, TTY users 711. We are available Mon - Fri, 8am - 8pm ET. You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.
    • Or enter your zip code where requested on this page to see quote.

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