When does the donut hole go away?


Answer

ObamaCare closes the Part D 'donut hole' from 2013 - 2020. This closes the gap for generic and brandname drugs, lowering the amount you pay in the coverage gap to 25% by 2020.

Prescription benefits improve: You can save money on brand-name drugs if you’re in the “donut hole”, you’ll also get a 50% discount when buying Part D-covered brand-name prescription drugs. The discount is applied automatically at the counter of your pharmacy—you don’t have to do anything to get it. By 2020, you’ll pay only 25% for covered brand-name and generic drugs during the gap—the same percentage you pay from the time you meet the deductible (if your plan has one) until you reach the out-of-pocket spending limit (up to $4,750 in 2013).

Year You’ll pay this percentage for brand-name drugs in the coverage gap You’ll pay this percentage for generic drugs in the coverage gap
2013

47.5%

79%

2014

47.5%

72%

2015

45%

65%

2016

45%

58%

2017

40%

51%

2018

35%

44%

2019

30%

37%

2020

25%

25%

Learn more about the donut hole and how the ACA closes it from Medicare.Gov.

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Nate Birr on


Answer Rating:

This is ridiculous. The donut hole should close completely…it should not exist. Elderly Americans should not have to choose between medications and groceries, and especially this time of year, some of them are forced to make this horrid choice because of our inhumane system that lets insurance companies profit off of people dying. It is disgusting, criminal, and unAmerican. We need Medicare part E for everyone!

justme123 on

You are absolutely correct. I have 3 scripts that are costing me well over 400.00 while in the hole

Frank Hill on

You do not know lucky you are. My Medical duductions were $17,000 last year. As the donut hole closes the cont of drugs increase. My insulin with no changes in the drug has increased 60%since 2013. There only two insulin producers in the U.S..All drugs increase as the donut hole increases. They take $4.00 drugs off the shelf and make1 insignificant change and raise the price to $100.00. This is allowed to happen because of the payoff to Congress. It is shameful.

Don Lewis on

OMG!!! Stop killing people!! Stop this damn “Gap” completely. Seniors have worked their entire life supporting the American economy and to think people are having to choose between mortgage or groceries to horrible. The price of insulin is over $1500.00 – how would you like to pay that – how could you? Bydureon $1000. and Forxiga is another $1200.00 — I take all three plus tier 3 heart drugs. I can’t afford 45% of gap costs. I may as well die. I will stop taking all medications until Jan.- “new year” But who really cares.

Janet on

I totally agree with you. My husband and I are in the same condition you are in and I am scared. I don’t want to die, but we can’t afford our medicine because of the donut hole. We are praying that someone does away with the donut hole. Don Lewis I guess we pray that someone does away with that donut hole

Becky Henderson on

Please contact your insurance company regarding lowering the tier on your insulin. I just got my husband’s novolog lowered to a tier 2.

Janet on

The donut hole is stupid. Older people have to chose either to get medicine or food. My husband and I worked hard and this is how we get treated. I advice people not to work get buy any way you can, my husband and I worked So we can’t get any help with our expensive medicine. Close the hole in the donut.

Valerie Rhead on

25% is still a lot of money (on something that costs, say, $1000 or more a month) for people on fixed incomes!!! The US needs to get a grip on the costs of prescription medicines for its citizens… Other countries seem to be able to do this. What gives?

Linda on

Closing the gap doesnt mean reducing it what bs

ObamaCareFacts.com on

Well it reduces it until 2020 at which point the gap between generic and brandname is closed.

R.J. on

Why is someone not going after Big Pharma? They don’t seem to have any responsibility for the outrageous prices. Diabetes is very common disease in the elderly. Volume of the sales should cover much of the initial expense in R&D. Has anyone compared the prices of the more common (older) drugs in the U.S. to Europe, Asia,Canada or South America?

Sharon on

Thank you Affordable Care Act for reducing the donut hole cost to seniors for generics by 54% from 2013 to 2020. If they appeal the ACA, I haven’t heard any politician propose anything better. I appreciate the help from the donut hole reduction.
By the way, the only cut to Medicare I have found in the ACA, is to Medicare Advantage which was supposed to happen anyway. From the beginning Med Advantage has received government subsidy that has exceeded the cost to the government of traditional Medicare. From inception, it was supposed to gradually be reduced to make the cost equal. Thanks to lobbyist that didn’t happen. The ACA cut to Medicare was supposed to be that cut. Make a level playing field for costs in both Medicare programs to the government. Fair to me.

Olivia Torres on

There are a lot of people like me that cannot afford this donut hole Obama screwed us seniors real bad.This is why there is so many seniors not able to get their prescriptions filled and go without eventually dieing.These are supposed to be our golden enjoyable years but has become a nightmare for many of us.Either we don’t qualify for help or don’t know about any one wanting to help.It really is a shame with medicare doing this to seniors who worked most of their lives to enjoy retirement.we should not have to chose between buying groceries or doing without to pay for prescriptions that we need to survive and be healthy.

ObamaCareFacts.com on

Well Bush essentially created the hole and Obama is essentially trying to fix it (with the ACA provision that closes it offers assistance to seniors). So while the frustration you feel is valid, pinning it on Obama is a little off-base. However, I agree, Medicare can present some very difficult options for seniors and while the private market certainly can have a place in senior coverage, it can feel frustrating when we consider the high costs that come with it whether we are talking about medical or drug plans, original or supplementary.

Laura Hutchison on

So tired of the doughnut hole as I am a diabetic !! Insulin is outrageous and our Co pays are counted in !!! Get rid of it and help the people that are retired !!! Ok let’s see medicine or food ? In the middle cannot get help cannot afford my medicine !!

Bill on

Novolin N and Novolin R (sold under the Relion name at Walmart) are $25.00 per bottle. Not the pens and not the NovoLOG.

Alan Wasserstein on

What is the parameters of the gap. At what amount does it begin and when does it end?
Are the costs calculated at AWP?
Thanks

Anthony on

Just because the donut hole is closed does not make drugs “free” someone is paying for them, possibly people who are now working by having their medicare withholding raised. I agree prescription drug prices are too high but more than likely that will not change so the finger pointing will continue as to who should pay for medicare prescription drugs, the people on medicare now who are taking the drugs who mostly can not afford them or people who are still working by paying in to medicare at a much higher rate than those who are now using medicare. When people talk about how they worked hard to be able to use medicare one day I don’t doubt that at all but the medicare withholding rate is 1.45% which equates to a person who made.$100,000 in income paying in $1,450 to Medicare, over a 40 year period would equal $58,000. I know the 4 days I spent in the hospital after a heart attack and having a stent placed was a $70k bill so $58,000 is not much when it comes the cost of a hospital stay. Which means most people are using Medicare at a much higher rate than they paid in. I am by no means saying people do not deserve it or didn’t work hard, I am.only using it to illustrate how much of a different there is between what people pay in to medicare versus the cost of the medical and prescription drug coverage they receive. Like most things involving the government there is no easy answer but just because the government alleviates one group of people having to pay for something out of pocket doesn’t mean that it’s “free” it just means a different group of people are having to pay for it in the form of higher taxes and/or payroll withholding.

Tony on

The so called donut hole came about in 2003 due to across the board budget cuts proposed by Congress. It was in a Medicare reform. While nearly everyone agrees that the annual budget deficit which this past fiscal year was $503,000,000,000(billion) of the $4,170,000,000,000(trillion) total annual budget is a major problem and needs to be addressed EVERYONE agrees that it needs to be done without affecting them financially in any way. Just as a visual aid the United States government total debt earlier this year was $19,400,000,000,000
as in 19 TRILLION 400 BILLION DOLLARS. If you had that amount of money in $1 bills you could cover over 4 BILLION football fields with it All I am trying to point out is the government can not afford to pay everything for everybody but no one wants to be the one who the government says must pay for at least part of their benefit.

Pmorgera on

Close the gap now! Elderly people suffer. No excuses. What type of insurance do our senators, reps, etc., have? Who is voting to help the people? Also on top of everything else, l pay over $300 a month just to be in these plans. Why you ask…because of hospital expenses! I supported this country from 1956 until I retired. Now what!

Mike Hunter on

Thank you Obama – for the donut hole – you make the middle class take care of everyone – I’ll be glad when you and your dishonest greedy politicians are out of the Whitehouse – plus the greedy pharmaceutical companies – between you, the pharmaceutical cos. and Lying Hilliary we have to pay for everybody’s drugs – thank you

Judi on

I’m really tired of seniors being uninformed about the donut hole. In their haste to blame Obama for everything, they aren’t taking the time to understand the history. Obama did not create the donut hole. It existed before he was elected. The “terrible” thing that Obama did was to recognize the problem and include a 10 year schedule to fix it in the Affordable Care Act. So, all you seniors who happily voted for Trump just screwed yourselves. When he repeals the ACA, the march towards elimination of the coverage gap stops. Still happy with your choice for President?

GREGG L on

Again, Bush created the donut hole. Obamacare reduced the hole, albeit over a number of years. Repeal of Obamacare will bring back a large donut hole. Oh, and by the way, if you are trying to parrot Trump then the correct term is Crooked Hillary..:(

pslice on

I think you may want to rethink that criticism now that Trump is in. Trump is going after the ACA which how Obama was closing the donut hole. If the ACA is dumped the donut hole springs back to what it was, huge.

Marcia ford on

The current rate of drug price increases offsets any relief from shrinking the donut hole. Add to that an almost negligible increase in social security payments and you are left with an army of senior citizens that must view drugs as a luxury. We might go to the doctor, but the prescription never gets filled.

Bart McMurray on

From 2013 thru 2016 I have paid about the same amount for my prescriptions because the drug companies have increased prices to compensate for the discount. Why did the government let this happen?

40mills on

These horrendous drug prices can be blamed directly on George w bush. He made a deal with pharmaceuticals that Medicare could not negotiate prices. He gave big pharma complete control over how much to charge! You can thank gwb for that.

ObamaCareFacts.com on

100% true.

Henry Hide on

I take Eliquis which is 6.00 + per pill in USA and 1>35 in Canada. Next year I will order from there during donut hole.

George l l Schafer sr on

Right on, when in the donut hole I order advair and spareva through Canada at a very low cost retail, sad!!!

Linda Palmer on

Will this provision go away if and when Obamacare is repealed

Judith Passmore on

Just two of my Meds cost me almost 430.00 a month while in the donut hole. Yet while I was working and paid into my insurance there was no such thing as a donut hole. I understand that my employer paid for most of the ins cost but now retired I pay more for my health care because I have a supplement, cost for part D, and medicare hospitalization which amounts to close to 500.00 when you add in my dental ins. So now by June I’m in the donut hole and spending close to a 1000.00 each month to stay alive. Do I need to die.

Robert F Krueger on

With Obamacare repealed and changed, will the above donut hole subsidy still be in effect?

Jim Sullivan on

So really, the only change made to the donut hole that was not already scheduled, was a 5% reduction on name brand drugs that was scheduled to take place in 2020. The donut hole still exists, just the amount you pay while in it has changed slightly. I look to the insurance companies to raise co-pays, and the drug companies to raise their prices to compensate for this.