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

• The Donut Hole (or Coverage Gap) begins when the total spent on drugs exceeds $2830
  
  
• The $2830 total includes the amount spent by you plus the amount spent by your insurance company
  
  
• The $2830 threshold total does not include monthly premiums paid by you
  
  
• The Donut Hole (Coverage Gap) ends when you have spent a total of $4550 of your own money on drugs (not including the money you spent on monthly premiums)
  
  
• While in the Donut Hole you must pay 100% of the cost of your drugs unless your Part D plan offers special Donut Hole or Gap coverage (only a few plans offer this special coverage and most of these plans only cover generic drugs)
  
  
• Some plans allow you to purchase drugs while in the Donut Hole at the lower price negotiated by the insurance company while others require that you pay the full retail pharmacy retail list price
  
  
• Once you have spent $4550 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.

  New benefit under the Affordable Care Act of 2010

  Medicare to send $250 to Part D enrollees who reach the Donut Hole during calendar 2010

   

  Seniors enrolled in a Medicare Part D Prescription Drug Insurance Plan in 2010 with any spending in the Donut Hole (Gap) will receive an automatic one-time rebate of $250 from Medicare, if they are not already receiving Medicare Extra Help. This benefit was created under the Patient Protection and Affordable Care Act amended by the Health Care and Education Reconciliation Act of 2010 passed by Congress and signed by the President in 2010. The payments will be sent automatically – no action on the part of the Part D enrollee will be required.

  
  Action Required for Next Year
  
  

  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 free counseling can help. Register with us now and we will contact you in late October to let you know when Medicare has released the information concerning Part D Insurance Plans for 2011.

  Call today toll free 866-928-1875 or email seniorinitiative@gmail.com