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Here Are a Few Ways to Fill in the Medicare “Donut Hole”

2 years ago · by · 0 comments

Have you heard about Medicare’s “donut hole”? It’s far from a delectable pastry and considerably less pleasant than the sugary goodness you can buy at your nearest donut shop. Rather, it represents a severe financial gap between governmental compensation for your medications and the rates you pay in addition to your Medicare insurance. While the “donut hole” is nowhere near as massive as it used to be, thanks largely to the help of “Obamacare” (otherwise known as the Affordable Care Act), seniors in this day and age will still have to compensate in one way or another for the gap. We have some tips on how you can make the Medicare “donut hole” easier to swallow.

How Does the “Donut Hole” Work?

Not all Medicare plans are created equally. Some offer coverage that only spans so far, especially where your medications are concerned. They may cover only specific drugs, or they may cover your medications up to a very specific total, which they will not exceed. Regardless of how your coverage works, you are left at a disadvantage. It will be up to you to pay for whatever the “donut hole” leaves out, and you’ll know how much this will be with every month you need to get a prescription filled. Your insurer will inform you directly of your status as far as the gap and about any and all payments you’ve made thus far.

What Exactly Does the “Donut Hole” Cover?

The answer to this question depends partly on the Medicare plan you chose when you first registered. Each form of Medicare supplement insurance covers a different type of medical need. If you find you fall into the “donut hole’s gap, know that these few parts of your coverage will still be naturally accounted for:

  • The amount you can save for your medications, regardless of its brand
  • Partial payments for a segment of your medications
  • Markdowns for any specified brand medications

It is worth noting that since the implementation of Obamacare, the gap has not only closed significantly but will eventually vanish altogether. Experts project that the “donut hole” will be completely devoured by the year 2020.

How Can I Protect Myself in the Meantime?

Luckily, you have several options at your disposal beyond waiting patiently for the Medicare gap to close on its own. Here are a few ways you can make sure you’re compensated for what the gap fails to insure and receive some sort of savings later on:

  • Letting yourself hit the gap
  • Not receiving Extra Help
  • Registering for either an Advantage Plan or Prescription Drug Plan

It is worth noting you must meet all three of these conditions in order to qualify for Medicare gap savings. If you are unsure of where you stand on either side of the gap, or just want more information on what this all means, you can always get in touch with a Medicare insurance agent. Be sure to also contact us to learn how you can make the most of your Medicare coverage and receive full benefits, no matter your situation.


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906 Brandywine Blvd. Suite 204,
Wilmington, DE 19809

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