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

All figures below are for calendar year 2014

  • The Donut Hole (or Coverage Gap) begins when the total spent on drugs exceeds $2850

  • The $2850 total includes the amount spent by you plus the amount spent by your insurance company
  • The $2850 threshold total does not include monthly premiums paid by you

  • While in the Donut Hole you will pay only 47.5% of the negotiated retail price for any Brand name drug that you purchase. When you purchase generic drugs, you will pay 86% of the negotiated retail price unless your specific Part D plan offers a greater discount. Most plans will offer no more than the 14% discount.

  • 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)

  • 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.

    Action Recommended for Evaluating Next Year's Part D Plans

    Step 1 - Call us today to register for counseling in November – 781-828-1875

    Step 2 – We will call you in early November to 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, 2013 and December 7, 2013 or No, I wish to stay with my present Part D plan for 2014 – 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 free 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.