The Doughnut Hole in the Medicare Part D Prescription Drug Program

Want to know the latest information about the 2010 health care bill and the donut hole? Find information on the Medicare Part D Prescription Drug Plan Coverage Gap in 2010 including news about the $250 refund issued one time to seniors who reach the donut hole in 2010.

For historical 2009 information on the donut hole coverage gap, continue reading this page.

The "doughnut hole" in the Medicare Part D prescription drug program did not get any smaller in 2009. Those on the drug plan D who have high prescription drug costs were out of luck getting coverage when they reached the coverage gap. In 2009, this gap, or "doughnut hole" as it's called, was the amount an enrollee would have to pay above $2,700 in drug costs and below $4,350 out of pocket.

What does this mean? Well, if you're on Part D in 2009, besides paying for the cost of the prescription drug plan plus your copayment or coinsurance on drug costs to $2,700 (that number includes both what you've paid and what the plan has paid), you're now paying 100% of your drug costs until you've dug deep into your pocket and shelled out $4,350, including your deductible and copay (but not the cost of the plan - that, unfortunately, doesn't count toward the limit).

After you've paid $4,350 out of pocket, you're in better shape, since you're on catastrophic drug coverage for the rest of the year and only responsible for 5 percent of your prescription drug costs.

All told, the annual dent in the budget of a senior or disabled person whose drugs are costly is significant.

It's not a pretty picture, but there may be options for you to cover you during the period of the doughnut hole coverage gap.

For those patients who are on the prescription drug program (Part D) with a coverage gap, Medicare recommends you:

• Switch to lower-cost medications or generic drugs, if your doctor thinks they would work as well.
• Seek out local or national charity programs--for example, the National Organization for Rare Disorders--which might have programs that could belay some of the drug costs.
  
• Seek out any assistance programs offered to Medicare Part D patients by the pharmaceutical companies.
  
• Get Extra Help from Social Security--you may be eligible if you have a low income and savings. Visit Social Security's website, or call 1-800-772-1213 or TTY 1-800-325-0778.  If you qualify for Medicaid as well as Medicare, you automatically are eligible for Extra Help.