Medicare Donut Hole

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The Donut Hole for Medicare Part D Prescription Drug Coverage

Medicare Part D Prescription Drug coverage has four phases. Deductibles, co-payments, co-insurance and other figures change each year.

The Donut Hole is Shrinking!

When Medicare Part D was created in 2006, enrollees paid 100% of all drug costs while in the donut hole. But the Affordable Care Act in 2010 gradually began to shrink the donut hole. It will close by 2019, so that you will pay no more than 25% of the cost of any brand name drug while in the donut hole.

Nearly 1 in 10 Part D enrollees had drug spending above the catastrophic coverage threshold in 2015.

9% Enrollees with spending above the catastrophic coverage threshold 3.6 million 91% Enrollees with spending below the catastrophic coverage threshold 37.7 million

Source: Kaiser Family Foundation 2015

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