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Medicare Donut Hole

The Medicare donut hole 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 2012 is $2930.

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 $4,700.

This number was calculated in a new way beginning in 2011

• In 2011, and continuing in 2012 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 $4,700 (left the donut hole) catastrophic coverage kicks in and you will have to spend $2.60 per month for generics / $6.50 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

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