The Medicare's prescription drug coverage Part D donut hole (coverage gap) has been slowly closing since the Affordable Care Act passed in 2010. However, the gap is closing beginning of 2019. Beneficiaries no longer have to choose between expensive medications that work vs medications that cost less, but aren’t as beneficial. To clarify, the “donut hole” still exists, but pharmaceutical companies will now be required to pick up more of the tab.
Changes to the 2019 Medicare Part D Donut Hole
- Brand name drugs will be covered at 75%, reducing your shared cost to 25%.
- Generic drugs will be covered at 63%, reducing your shared costs to 37%.
- Standard initial deductibles are projected to increase from $405 to $415 a month.
- Your initial coverage limit is projected to increase from $3,750 to $3,820.
- The donut hole TrOOP is projected to increase to $5,100 from $5,000. However you are paying less money out of pocket to reach the $5,100.
- After you reach the $5,100, you become eligible for catastrophic coverage. At that point both your generic and brand drug purchases will be covered at 95%.