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Donut Hole Information

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• It is the coverage gap in Medicare Part D Drug Coverage, where you are not insured for the cost of drugs

• The gap amount, or dollar threshold where you lose coverage for 2011 is $2840.
– This number is calculated on retail costs of the drugs, not what you personally spend, i.e. co-pay or co-insurance.

• You exit the Donut Hole when your total out of pocket expenses reaches $4,550.
– This number is calculated in a new way beginning in 2011

• NEW in 2011 when you are in the Donut Hole you will receive discounts of 50% on Brand drugs and 7% on Generic drugs, this will keep you in the hole longer though.
– For exiting the donut hole, calculations include not only what you have paid toward your prescriptions, but also what specific extra help programs have paid toward your medication costs.

• After you have spent $4,550 (left the donut hole) catastrophic coverage kicks in and you will have to spend $2.50 per month for generics / $6.30 per month for name brand medications or 5% of the medication’s retail cost, whichever cost is higher.

• Healthcare reform plans on eliminating the Donut Hole in 2020 with small increases in the discount each year after 2011

 

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