Sweet Assurance for Chronic Conditions
Our Gap Coverage has you covered with copays as low as $0*!
*Benefits vay by plan
Welcome to Your Guide on Medicare Prescription Drug Plans & Understanding the “Donut Hole”
Are you currently navigating through the complex world of Medicare prescription drug plans? We understand that health is a top priority at this stage in life, especially for those dealing with chronic and non-chronic health conditions. We are here to help you make sense of a crucial aspect of Medicare drug coverage – the infamous “Donut Hole”.
What is the "Donut Hole"?
The “Donut Hole” is a term used to describe a coverage gap in Medicare prescription drug plans, where your usual cost-sharing terms might shift, temporarily changing how much you pay for your medications. This is an important phase to understand, as it can have a significant impact on your out-of-pocket costs.
How does it work?
Entering the Donut Hole
You find yourself in the “Donut Hole” once you and your drug plan’s total spending on covered drugs reaches $4,660 in 2023, or $5,030 in 2024. This includes your deductible, copayments, and coinsurance, as well as what the plan pays and any discount on brand-name drugs.
Cost-Sharing in the Donut Hole
In this phase, you may be required to pay 25% of the cost for both brand-name and generic drugs. However, this can vary depending on your specific plan, as some offer additional coverage during the gap. Make sure to review your plan’s Evidence of Coverage (EOC) document to understand your exact cost-sharing responsibilities.
Exiting the Donut Hole
Your time in the “Donut Hole” concludes when your total out-of-pocket drug costs reach $7,400. This includes what you’ve spent on covered drugs during the deductible and initial coverage phases, as well as what you paid during the coverage gap. Note that nearly the entire cost of your drugs counts toward this out-of-pocket limit.
Why is this Important?
Understanding the “Donut Hole” is crucial in planning your healthcare expenses for the year. Being aware of these phases and the associated costs can help you budget more effectively and avoid unexpected expenses.
When you hit the coverage gap, Gold Kidney has you covered
Gold Kidney Medicare Advantage plans have you covered in the coverage gap with copays as low as $0 per prescription, covering many name-brand drugs* including Farxiga®, Jardiance®, Ozempic®, ®, Trulicity®, Victoza® 3-Pak, and many more. We help you navigate the “donut hole” with confidence to make the most of your Medicare Advantage plan benefits including additional prescription drug benefits when you need them most. Click on the buttons below to learn more about your options.
*Benefits vary by plan
Need Help Navigating the "Donut Hole"?
We’re here to assist you! If you have any questions or need clarification on how the “Donut Hole” impacts your specific Medicare prescription drug plan, please don’t hesitate to contact us. Our team of experts is dedicated to helping you understand your coverage and ensuring that you are prepared for every phase of your Medicare journey.
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