What You Need To Know About Donut Hole
Donut hole also known as coverage gap occurs when the Medicare plan has reached its limit of payment for your covered drugs in a year. There is a limit to which your plan can cover for the drugs you get and if this limit is reached within a year, you reach a donut hole. Not everyone gets to this point. In this situation, you will be expected to cover a percentage of the drugs that are prescribed to you.
For brand-name prescription and generic drugs, you will be expected to pay at most 25% of the cost of this drug. You can however get out of this situation if you reach catastrophic coverage [6]. Catastrophic coverage is a protective phase that prevents you from overspending on prescribed drugs. Catastrophic coverage is reached after you have spent up to a certain limit.