INSURANCE

Q: Do you have any updated information on the Part D ‘Donut Hole’ for 2018? A: For those new to Medicare, the ‘Donut Hole’ is a commonly used nickname for Medicare Part D’s Prescription Drug Coverage Gap. It is the point when many older adults have to shoulder a greater share of their prescription drug costs. For 2018, the threshold for entering the donut hole is when both you and your Medicare Part D plan spend a total of $3,750. Once you enter the Coverage Gap in 2018, you will pay 35% of your plan’s cost for covered brand-name prescription drugs and 44% of the cost for generic drugs. The percentage discount will come off of the price your plan has set with the pharmacy for your specific drugs.

You will remain in the donut hole until you reach the next dollar limit of $5,000, when you move into The Catastrophic Coverage phase. In the 2018 Catastrophic Coverage phase, you will pay $8.35 or 5% of the cost for brand name drugs or $3.35 or 5% for generics, whichever is greater.

It is important to remember that it is not just your share of your drug costs that puts you into the Donut Hole. The amount your part D prescription plan pays also counts towards the threshold.

Items that do not count towards the Coverage Gap include the premium you pay for your drug plan, any pharmacy dispensing fees and anything you pay for drugs that are not covered.

If you think you’ve reached the coverage gap and you do not get a discount contact your drug plan to make sure that your prescription records are correct and up-to-date.

Medicare’s prescription drug donut hole is getting smaller. Your percentage of the costs will continue to go down every year until 2020 when it will stabilize at 25% once you reach the coverage gap. Medicare Open Enrollment is going on now. You have until December 7 to make changes in your coverage. If you have questions concerning Medicare Advantage Plans or Medicare Part D Prescription Drug Plans, please call me at 440-255-5700 or email me at Lmutsko@ mutskoInsurance.com. I look forward to helping you.