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Tips on Avoiding the Medicare Doughnut Hole


Every year, one-quarter of Medicare Part D enrollees fall into the dreaded Doughnut Hole — a coverage gap that results in skyrocketing out-of-pocket prescription drug costs.

Helping seniors to pay for prescription medication, in 2013 Medicare Part D has offered financial assistance up to $2,970 and then kicking in again when drug spending hits $4,750. When individuals enter the gap, the government kicks in a 50 percent discount on brand-name prescription drugs and a 21 percent discount on generic prescription medication (the latter will increase to 28 percent in 2014).

For the 3 million people who fall into this Doughnut Hole every year, however, mustering the finances to pay for 50 percent or even 79 percent of sometimes expensive medications isn’t always possible.

Although the gap is set to close in 2020, how do wade through its murky waters safely over the next several years? Here are some tips we’re suggesting to make sure the Doughnut Hole doesn’t eat you alive.

  • Plan ahead! If you suffer from any chronic illnesses, chances are you have a regular regimen of prescription drugs that you anticipate taking on a daily basis. By calculating how much your prescription drugs will cost you, you can figure out if and when you’ll enter the gap.
  • Work with your doctor. Despite their best intentions, many doctors aren’t always aware of the challenges that their patients face. Ask about free samples, different medications you could take that might lower costs, or whether you could purchase a higher-dose drug and split it.
  • Use online tools to plan. Check out the AARP’s Doughnut Hole Toolkit to see how you can help yourself or a loved one avoid the Doughnut Hole.
  • Shop smart! Consider buying prescriptions online through a trusted pharmacy like IsraelPharm, where you know you can trust the pharmacist to guide you in making the right decisions whether you’re in the gap or quickly approaching it.

Whatever you do, don’t panic! Even with the best intentions and planning, many people still fall into the Doughnut Hole, but typically late in the year (benefits reset every January — phew!). Above all, stay on track with your medications. Whether you have to dig into savings, cut corners on your budget, or borrow from friends and family, making sure to continue your prescription drug regimen is of the utmost importance for your health.

Have you entered the Medicare Doughnut Hole in the past? How did you survive and what tips do you have to offer others to avoid the gap? 

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