Posted by MedEd at MHI
A: Both! The Donut Hole (also known as the Coverage Gap) for brand name medications is going away in 2019, but the Donut Hole for generic medications will still be in place until 2020.
The closure of the Donut Hole doesn’t mean you’ll get your medications for free. It means the coinsurance you pay while you are in the Donut Hole will be reduced to 25%.
[Before we go too far down this road, let’s talk about who might fall into the Donut Hole. Although it’s not a guarantee, you will minimize your chances if you can use generic instead of more expensive drugs.
You’ll enter the Donut Hole when the total of what you and your drug plan have paid for your medications in 2018 reaches $3750. Review your monthly statement or call your drug plan to check how close you are to this amount.
Those of you receiving “extra help” (also called the low-income subsidy, or LIS) will not “fall into” the Donut Hole.]
Now, back to the closure of the Donut Hole… We’ll look at brand name medications first. This year (2018), you pay 35% of the cost of your brand name medications while you are in the Donut Hole. The plan was for your share of the cost to be reduced to 30% in 2019 and 25% in 2020. The Bipartisan Budget Act of 2018 changed that – in a good way. You’ll reach the 25% coinsurance level on your brand name medications in 2019 now instead of 2020 - a year earlier than originally planned.
The scheduled phase-out of the Donut Hole for generic medications has not changed. You pay 44% of the cost of your generic medications this year, 37% in 2019 and finally in 2020, 25%.