top of page
Writer's pictureJamie Byrd
Mar 43 min read

The Medicare Donut Hole 2024 Simplified

Updated: May 7


With Senior Solutions, the Medicare Division of The Bedrock Group, we can help with confusing Medicare terms such as The Donut Hole
Let's clarify the Donut Hole concept in a straightforward manner.

First, let's try to make the idea of the donut hole less confusing. The Medicare Part D Donut Hole is called this because there is a hole in the middle of your drug coverage during the calendar year, which is officially called the Coverage Gap, and by 2025, the Coverage Gap will go away. However, since it is still in use, let's try to break it down.


  • When you and your plan spend a total of $5,030 in 2024, you enter the Donut Hole

  • When you are in the Donut Hole, you will pay up to 25% out-of-pocket for all covered medications

  • Once you have spent $8,000 out of pocket for covered drugs, you leave the Donut Hole

  • 2024 will be the last year for the Donut Hole. In 2025, a $2,000 out-of-pocket cap takes effect for Medicare Part D


For example, when you and your insurance plan have reached $5,030, you move into the Donut Hole and pay up to 25% out-of-pocket for all prescriptions. Let's say you have a $100 tier 2 drug, and you were paying $10 before you were in the Donut Hole (Coverage Gap). You now will pay $25. While in the Coverage Gap (Donut Hole), Medicare will continue to tally the spending between you and your insurance until your out-of-pocket drug expense reaches $8,000. At this time, you will exit the Coverage Gap (Donut Hole) and will no longer pay for your covered prescriptions for the remainder of the year.


Not everyone will enter the coverage gap, and this doesn’t apply to members who get Extra Help to pay for their Part D costs. So here's what counts towards moving out of the Donut Hole (Coverage Gap):


  • Your yearly deductible, coinsurance, and copayments

  • The discount you receive on brand-name drugs

  • What your plan pays


When you are in the Coverage Gap (Donut Hole) and paying the 25% of covered drugs, your spending will count towards exiting the Gap ($8,000). One good thing is that you receive help exiting the gap sooner because the manufacturer's discount of 70% counts. Also, most Part D carriers negotiate discounted drug rates, and you get the benefit of the discounts just for being a plan member.


Suppose you would like to avoid spending extra money while in the Coverage Gap; there are steps you can take.


  • You can use generic over brand-name drugs.

  • You can also compare prescription drug plans each year to ensure your plan offers the best coverage for your medications.

  • Depending on your financial situation, you could qualify for Extra Help, a low-income subsidy designed to help with prescription drug costs.

  • Use your drug plan Mail-order service.

  • Fill your prescriptions at the plan's preferred pharmacy

  • Look for pharmacies with a drug program, such as Walmart which has lists of generic medication to purchase for $4.

  • If you have Veterans benefits, filling your expensive medications at your VA could help. Be sure to contact your local VA for details.


At Senior Solutions, the Medicare Division of The Bedrock Group, our advisors can help you navigate everything regarding your retirement and Medicare. We are happy to be there for you, how and when it is convenient.


In-person appointment: 833-905-1060

Over the phone consultation: 502-200-1516


Click here for your FREE ebook copy of The Comprehensive Guide to Turning 65. You can download the guide immediately or subscribe to receive updates and enter your email. Within 10 minutes, you should have your ebook download link in your inbox.


Please continue reading below if you want more information about who we are.



Jamie Smith is the CMO of The Bedrock Group.

 

The Bedrock Group is a Veteran and First-responder full-serivce insurance agency.
With Bedrock, you can get the insurance coverage you deserve.

Want to know more?


At The Bedrock Group, we're a Veteran and First Responder-owned full-service insurance agency. We provide complimentary consultations and no-cost Medicare reviews. Our home office is located in New Albany, IN. We have a Senior Resource Center in Stanford, KY, and a full-service agency in Asheville, NC. We also offer the following services:


  • Life Insurance

  • Annuities

  • Wealth Management

  • Home + Auto

  • Renter's + Condo + Home Insurance

  • Medicare Plans

  • Medicare Advantage Plans

  • Medicare Supplement (Medigap)

  • Hospital Indemnity

  • Final Expense (burial planning)

  • Mortgage Protection

  • Business Insurance

  • Retirement Planning

  • Medicare Enrollment Help

  • + More

We service the following states: Florida, Georgia, Illinois, Indiana, Kentucky, Michigan, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Alabama, Connecticut, Nevada, and West Virginia.


If you have Medicare questions, you can call our team at 502-200-1516. If you want to schedule an in-person Medicare Benefits Review, please call 833-905-1060. If you would like a comprehensive overall review, call 833-905-1060 or email

hello@mybedrockfg.com with your contact information, including your name, city, state, and phone number, and we will connect with you.



58 views0 comments

Comments

bottom of page