What is the Donut Hole?

The “Donut Hole” is another name for the coverage gap most Medicare drug plans have.  This means there's a temporary limit on what the drug plan will cover for drugs.

You reach the coverage gap when you and your plan spend $5,030 on covered drugs in 2024.  This amount may change each year.

Once you reach this coverage gap, you will generally pay 25% of the cost for your prescriptions until you and your plan pay a total of $8,000 in 2024.  After you reach $8,000, Medicare and your drug plan will pay 100% of the costs. You will pay nothing for your prescription drugs after that.

Items that count towards the coverage gap

• Your yearly deductible, coinsurance, and copayments

• The discount you get on brand-name drugs in the coverage gap

• What you pay in the coverage gap

Items that don't count towards the coverage gap

• The drug plan premium

• Pharmacy dispensing fee

• What you pay for drugs that aren’t covered