Closing the Donut Hole

Posted:June 29, 2015

The Affordable Care Act has been working to close the Donut Hole in Part D plans.  The Donut Hole, also referred to as the coverage gap, begins in your drug plan after you have spent a certain amount for covered drugs. In 2015, you hit the donut hole once you and the plan have spent $2,960 on covered drugs (combined amount plus your deductible). Once in the donut hole, you are responsible for a percentage of the plan’s drug cost.  In 2015, the consumer is responsible for 45% of the plan’s cost for brand-name drugs and 65% for the plan’s cost of generic drugs. Once you’ve spent $4,700, you leave the coverage gap and enter catastrophic coverage. Catastrophic coverage ensure you only pay a small copayment for covered drugs.

The link below shows two charts (brand-name drugs and generic drugs) depicting how the percentage you are responsible in the donut hole has decreased over the years.  In 2010 the consumer was responsible for 100% of the plan cost for brand-name and generic drugs.  In 2020, the consumer is expected to be responsible for 25% of the plan cost for brand-name and generic drugs.