The Donut Hole of Part D and Medicare

Let Congress propose terms such as “donut hole” when drafting legislation, even when dealing with Medicare-related part D. As the details began to surface from the “procedure” of thinning Part D, several elements began to filter out and one of such elements was the “donut hole.” Later on, it would be dismissed and later partly addressed at a later date as part of health reform. It is important to understand what it is and how it affects what you can pay out-of-pocket for your prescription drugs if you are covered for Part D drugs through Medicare plan. So let us take a look at the donut hole to identify what we are.

To track back a little, what is Part D plan? Part D is the relatively new part of Medicare that has added the much-needed medical benefit to traditional Medicare. When conventional Medicare was formed, medication was not nearly the cost consideration it is today. There are new medicines that arise for more exotic and serious health problems that can cost thousands of dollars. Yes, this is not a typo. 10,000 a year for a particular drug. When conventional Medicare was drafted, the major factors were medical expenses (facilities and exams) and doctors’ costs. Part D was an important addition to original Medicare to solve the increasingly important (and costly) cost of outpatient drugs. So how does part D work and what is the coverage gap?

Part D is designed to be standardized by Medicare and provided by private companies. There were certain basic requirements or benefits that each plan should offer. Part of this calculation was the uncovered period. Essentially, Part D was created with 3 levels. The first level was an initial benefit that you could receive immediately or after a deductible according to the plan’s design. This would continue until a certain amount of drug expenses, after which you (a member of Medicare Part D) are responsible for the total cost of the drugs. Now, this is the 2nd level and the critical name “Donut Hole”. This amount will be paid by you for a period of time and move to the third level of Part D benefits or the “catastrophic” section in which the policy would apply. This is to protect a person from costs of very expensive medicines that would lead to bankruptcy. The concept of coverage gap was designed to help mitigate the cost of the new Part D benefit. Originally, the D Part Defenders accepted the coverage gap, assuming they could remove it at a later date, which proved to be a good strategy

The difference was later reviewed in the health reform process as part of a review of Medicare in the uninsured period will be eliminated by 2020. There are discounts and some discounts available within the coverage gap by type of medication. Certain Part D policies also address the uncovered period, so it is important for. you to know that you have significant medication costs to investigate how plans differ in this regard. Coverage can only be generic. To some extent, we only make a decision for the rest of the calendar year, so consider 2020 Medicare advantage plans comparison as we can change the plans for Part D during the open enrollment period each year.