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How is the doughnut hole going to close?


En español | The coverage gap or doughnut hole will gradually narrow until it disappears in 2020. If you reach the doughnut hole, you’ll get over a 50 percent discount on brand-name prescription drugs and over a 21 percent discount on generic prescription drugs while you are in the coverage gap. This means you will not have to pay 100 percent of the cost of all your drugs while you are in the coverage gap, as you would have had before the health care law was passed. Exactly how much you pay out of pocket will vary widely depending on the Part D plan you are in and the price your plan has negotiated.

However, even after the coverage gap is gone, everyone on Part D will still have the same level of cost sharing — about 25 percent — from the time you meet your deductible until the time you reach catastrophic coverage. Catastrophic coverage remains in place even after the coverage gap goes away. Catastrophic coverage starts when your total out-of-pocket drug costs have climbed to a certain amount. After that point, you only have a 5 percent copay.


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