The Medicare Part D Donut Hole 2022 is a coverage gap that affects many seniors. Once you reach a certain level of spending in a calendar year, you enter the donut hole. Once this happens you have to pay for all your prescription drugs out-of-pocket. In this blog post, we will discuss what the donut hole is, how it works, and ways to avoid it.
What is Part D Coverage Gap?
If Medicare Part D prescription drug coverage is new to you. You are not alone! Maybe you do not take many prescription drugs. So you may be wondering how the donut hole would even affect you. Put simply, the Medicare donut hole refers to the third of four progressive payment stages. This is in Medicare Part D prescription drug coverage. These four payment stages are:
- Deductible stage
- Initial coverage stage
- Medicare donut hole (coverage gap) stage
- Catastrophic coverage stage.
You may have had Medicare Part D coverage for many years and never experienced some of these stages and their related out-of-pocket expenses. For example, you may select a Medicare plan with prescription drug coverage that doesn’t have a deductible. In that case, you skip the deductible stage and go immediately to the initial coverage stage. Or, you may take generic prescription drugs. If so, the cost you and your Medicare Part D plan pay for your medications may never reach amounts that put you in the Medicare donut hole or catastrophic coverage stages.
But if you do have high prescription drug costs, you could still enter the “coverage gap” phase once you and the Medicare Part D plan have spent a certain amount ($4,430 for covered prescription drugs in 2022).
Knowing Your Troop
You’ll pay no more than 25% of the cost of your covered medications during this phase.
Then, if your spending on covered medications reaches $7,050 (in 2022 ), you’ll enter the catastrophic coverage stage. Your Medicare prescription drug plan will pay most of the cost of your covered medications for the balance of the year.
Tricks on How to Avoid The Donut Hole
If you’re new to Medicare Part D or have never used many prescription drugs under your Part D coverage, you may not be familiar with the concept of the Medicare donut hole. Put simply, the Medicare donut hole refers to the third of four progressive payment stages in Medicare Part D prescription drug coverage.
There are a few ways you can avoid the donut hole, or at least minimize your out-of-pocket costs. One way is to choose a Medicare Part D plan with no deductible, or a low deductible. This way, you can avoid the deductible stage altogether. Another way to avoid the donut hole is to take advantage of manufacturer discounts and coupons. Many drug companies offer these discounts to help Medicare recipients afford their medications. You can also ask your doctor if there are any lower-cost alternatives to the brand-name drugs you’re taking.
Finally, you can enroll in a Medicare Part D plan that offers “gap coverage.” This type of plan covers some or all of the costs of your medications during the donut hole stage.
Enrolling in a Medicare Advantage Plan
If you’re concerned about the costs of prescription drugs, you may want to consider enrolling in a Medicare Advantage plan. Medicare Advantage plans are required to offer at least the same level of coverage as Original Medicare ( Parts A and B ), but many plans offer additional benefits, such as prescription drug coverage. Some Medicare Advantage plans even offer $0 monthly premiums.
When you enroll in a Medicare Advantage plan, you’re still enrolled in Original Medicare. But your coverage is provided through a private insurance company, and you may have different costs and rules for using your benefits. For example, you may have to see doctors who participate in the plan’s network or use only certain pharmacies for your prescriptions.
When Can You Sign Up?
You can enroll in a Medicare Advantage plan during the Annual Election Period, which runs from October 15 to December 7th. If you’re already enrolled in a Medicare Advantage plan and you want to switch to another plan, you can do so during the Annual Election Period as well.
You can also enroll in or switch to a Medicare Advantage plan if you experience a “life-changing event,” such as moving to a new area or losing other health coverage.
If you have questions about the Medicare donut hole or any other aspect of Medicare, you can contact the Medicare helpline 24 hours a day, seven days a week at 800-MEDICARE. Remember, you can also call us with any questions you may have.
We hope you enjoyed our blog.