Explanation of the “Donut Hole” or “Coverage Gap”

All figures below are for calendar year 2019

  • The Donut Hole (or Coverage Gap) begins when the total spent on drugs exceeds $3750

  • The $3750 total includes the amount spent by you plus the amount spent by your insurance company
  • The $3750 threshold total does not include monthly premiums paid by you

  • While in the Donut Hole you will pay only 35% of the negotiated retail price for any Brand name drug that you purchase. When you purchase generic drugs, you will pay 44% of the negotiated retail price unless your specific Part D plan offers a greater discount.

  • The Donut Hole (Coverage Gap) ends when you have spent a total of $5000 of your own money on drugs (not including the money you spent on monthly premiums)

  • Once you have spent $5000 of your own money during the year, the catastrophic coverage begins. The individual pays approximately 5% of the cost of the drugs from then on until the end of the year. There is no carry-over from year to year. Each year all plans start anew.

    Action Recommended for Evaluating Next Year's Part D Plans

    Step 1 - Call us today for counseling – 781-828-1875

    Step 2 – We will evaluate your Part D plan

    Step 3 - Make a decision – change plans for next year or stay with present plan

    Step 4 - Yes, I wish to change plans - you must enroll anytime between October 15, 2017 and December 7, 2017 or No, I wish to stay with my present Part D plan for 2017 – no action necessary

    Everyone should re-evaluate their Part D Plan for the coming year. Plans change and a plan that is suitable this year may be too expensive next year. Our counseling can help.

    If you have questions regarding Medicare Part D, please call us.

    Call today 781-828-1875 or email seniorinitiative@gmail.com


The Senior Initiative Inc. is an independent, non-profit organization dedicated to helping
seniors with health and financial issues.