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 Who pays for prescription drugs while in the Medicare donut hole?

What is Medicare-Question
Who is responsible for the costs of medications if I'm in the donut hole of a Medicare Part D prescription drug plan?

Answer to What is Medicare question
Unfortunately, it's you.

The Medicare beneficiary who has the drug plan is responsible for the costs while in the donut hole, officially known as the Medicare Coverage Gap.

In the early days of the Part D drug plan, the beneficiary had to pay every penny of the costs in the donut hole. In the last few years, beneficiaries have received discounts on some medications. The discount is now 75 percent on all medications, brand-name and generic prescriptions.

  • A brand name drug that costs $100 has a discount of $75; you would pay $25. 
  • The discount for a generic medication with a cost $25 is $18.75; you would pay $6.25.

The copayment for the brand-name drug plus 70% of the discount amount and the amount paid for generic drugs (not the discount) count toward the $6,550 in total drug costs that it takes to get out of the donut hole in 2021.

Learn more about the donut hole.


Last updated: 12-01-2020