The Donut Hole is the most confusing and controversial part of Medicare. For many seniors it is also the scariest as reaching the Donut Hole can create significant financial challenges.
The Donut Hole or the Coverage Gap refers to the level of coverage in all Medicare Part D Prescription Drug Plans when the enrollee becomes responsible for 45% of the cost of brand name medications and 65% of the cost of generic medications.
In 2015, you reach the Donut Hole when the Total Retail Cost of your medications reaches $2,960. Total Retail Cost is what you pay plus what the insurance company pays when you get a prescription filled.
You get out of the Donut Hole and reach Catastrophic Coverage when your True-Out-Of-Pocket reaches $4,700. True-Out-Of-Pocket is what you pay plus the manufacturer’s discount (50% of the total retail cost) you receive on brand name medications when you are in the Donut Hole.
When you reach Catastrophic Coverage you pay the greater of 5% or $2.65 for generic medications or the greater of 5% or $6.60 for brand name medications.
Everything starts over January 1st of each year. The Donut Hole will be phased out by 2020.
For more information about Florida Medicare supplements, give Sun Coast Legacy Advisors a call at 888-455-5799 today!