What is Medicare Part D Coverage Gap ("Donut Hole")?
It is important to note that most people will not enter the coverage gap, especially those with Extra Help or Low-Income Subsidy (LIS). However, it is better to be prepared and try to prevent entering this stage and the extra costs related to it. Here are some ways to help avoid entering the donut hole:
1. Compare Medicare Advantage plans to find one with the best Part D coverage for your prescriptions. For example, UPMC for Life plans offer $0 copays for Tier 1 and Tier 2 prescriptions filled at a preferred pharmacy, which helps keep costs low.
2. Use in-network and preferred pharmacies.
3. Use in-network mail-order pharmacies or check online for discounted prices.
4. Choose generic drugs instead of brand-name whenever possible.
5. Talk to your doctor or pharmacist about drug alternatives at a lower cost.
6. Check to see if you qualify for Extra Help, a low-income subsidy that helps with the cost of prescription drugs.
Yes, 2024 is the last year for the donut hole.
Starting in 2025, there will no longer be a Medicare Part D coverage gap. The Inflation Reduction Act (IRA) of 2022 includes several ways to reduce prescription drug costs for Medicare Part D members. This includes limiting out-of-pocket costs by eliminating the donut hole and requiring Medicare Part D plans and drug manufacturers to pay a greater share of the costs in the catastrophic coverage stage.