How Medicare Smart Are You?

Medicare Part D Prescription Drug coverage has four phases: The deductible phase (in which a beneficiary pays the full drug cost until hitting a deductible), the initial coverage phase (in which cost-sharing begins), the coverage gap or “donut hole” (in which the plan stops paying) and the catastrophic phase (in which the beneficiary’s costs drop dramatically after the beneficiary has paid a certain amount.)
What change did the Bipartisan Budget Act of 2018 make to the donut hole?

The answer is “B.”

It decreases the beneficiary contribution to 25% of prescription costs in 2019, instead of 2020.

When Part D prescription drug plans were introduced in 2006, Plan D enrollees were responsible for 100% of the drug costs while in the coverage gap. Health care reform in 2010, however, gradually lowered that percentage. The gap was scheduled to close to 25% by 2020, but the Bipartisan Budget Act of 2018 pushed that date up to 2019.

The coverage gap is confusing. You don't have to understand it to help your clients. If they have questions or concerns about it, show them our 'Understanding the Donut Hole' infographic and suggest they call Medicare BackOffice. Our Licensed Insurance Agents or our pharmacists can answer their questions, and you'll score points with your clients for helping.

Tip: If you don't want to wait until clients ask about health care concerns, email them first. You can use National Donut Day — which is June 1 this year — as a time peg to email the link to the donut hole infographic to your clients enrolled in Medicare or approaching enrollment at age 65. You can find the donut hole graphic under the Resources tab in our library.

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