As a young child, I remember my dad going to the local donut shop and bringing home delicious treats for our Saturday morning family breakfast. Thinking back, I remember the wonderful glazed donuts, the nut covered donuts, and the donuts with cream filling. But I don’t ever remember getting donut holes, which are frequently found in our workroom kitchens nowadays.

Fast forward many years to when I took my dad to his first oncology visit and we left with a prescription for treatment of multiple myeloma. We were sent to a specialty pharmacy that had this medication. The pharmacist came out to the waiting room to ask my dad if he really wanted this medication. To our surprise the first 30-day supply of this drug cost $4,000 and quickly put my dad into the “donut hole” with his Medicare pharmacy plan. His plan would cover a portion of the cost, but he was going to be responsible for paying a large portion until he got out of the “donut hole.”

So, what is the “donut hole,” as it applies to Medicare? In 2017, once you have spent $3,700 on covered medications (including your deductible) you have reached the coverage gap or “donut hole” for your Medicare prescription plan. At that point, you will be required to pay 40% of the plan’s cost for all brand name drugs and 51% for generics until your out-of-pocket expenses have reached $4,950. If you have spent this additional amount, you reach the catastrophic phase and are responsible for a small co-payment towards any additional medications until the year ends.  

Medicare insurance issues are tricky to understand, but Severino Health Advisors is there to help you understand your insurance bills. We can also refer you to experts in Medicare policies who will find you the best plan for your needs.

Contact us today, so that we can help you and your loved one.