The "Donut Hole"

Updated: Sep 12, 2018


Real donuts are delicious. Medicare's donut hole is not

To many people (including me), donut holes are delicious comfort food. However, the "donut hole" in Medicare Program D is not as welcoming. This type of "donut hole" means the prescription cost that Medicare will NOT reimburse after it has covered a certain amount of money. Medicare members will have to pay their prescription out of their own pockets until their medication exceeds their maximal deductible on prescription. The minimal and maximal limit of prescription coverage that Medicare members are responsible for change every year.


The 2018 "donut hole" exists between $3,750 and $5,000. In other words, the Medicare plan will reimburse for a member's medication until $3,750. Once the member's prescription costs more than $3,750, the member has to pay on his/her own until his/her medication reaches to $5,000.


Many seniors, like my in-laws, did not know about "the donut hole" until one day they received a big prescription bill. I still remember the shock on my in-laws' faces when I explained to them what Medicare Donut Hole meant to their prescription costs. They immediately accepted my suggestion on keeping their second PPO healthcare plan as the supplement if they got their "donut holes."


"Donut hole" stresses many seniors, especially ones with chronic diseases like diabetes and strokes. Thankfully, Obamacare, or the Affordable Care Act, is gradually decreasing the size of the "donut hole" and plans to close the hole completely by 2020. However, because of the current political atmosphere, the plan is no longer affirmative.


Therefore, keep your PPO/HMO healthcare plans if possible, even if you are already a Medicare member. Your secondary healthcare plans will come handy when you get your donut holes. Furthermore, stay active and eat healthy to keep your prescription as minimal as possible. Of course, getting services from a great senior home care services provider like El Roble Home Care is equally critically, because you will get the best home care plans to keep you stay active and take medicine on time! You should enjoy your Golden years instead of worrying about how to pay for your medicine all the time. :-)



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