Relief Is on the Way – Medicare Prescription Donut Hole to be Closed by 2020

If you’ve ever fallen into the Medicare Part D prescription donut hole, you know what a nightmare it can be paying high out-of-pocket costs for your medications. But relief in coming – and sooner than you might expect!

Included in the Affordable Care Act is a provision to close the donut hole over the next several years. Currently, once a Medicare beneficiary’s prescription costs have reached $2,850 in a given year, they enter the so-called donut hole. At that point, beneficiaries are responsible for a large portion of their prescription costs. Normal coverage kicks back in once prescription costs hit a total of $4,550.

If a Medicare beneficiary enters the donut hole in 2014, they must pay 47.5 percent of the cost for brand-name drugs and 72 percent of the cost for generic drugs until their total drug costs reach $4,550 for the year. That’s a tremendous out-of-pocket expense when you’re on a fixed budget!

How Will Closing the Donut Hole Affect Me?

Every year from now until 2020, Medicare beneficiaries will pay less and less for their drug costs once they enter the donut hole until the hole is completely closed in 2020, as you can see below:

Once the donut hole is closed in 2020, you’ll pay the same 25% percent as you normally would for brand-name and generic prescriptions. This is welcomed news for Medicare beneficiaries who have struggled to purchase their prescriptions in the past – many prescriptions which would cause life-threatening consequences if they didn’t have their medications!

What are you thoughts on Medicare closing the prescription donut hole? What has your experience been with the donut hole in the past? Do you have any other questions you would like for us to answer?

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Wiley Long

Wiley Long is president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. When he’s not working he’s likely to be skiing and hanging out with his wife and son, and enjoying the live music scene around Fort Collins, Colorado.

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