23 thoughts on “Your Costs in the Medicare Donut Hole | Medicare Part D Coverage Gap

    • The insurance carrier decides which tier to place a drug in. However, they cannot place a medication into the Specialty tier unless the drug has a retail price tag of over $600.

    • It would depend on the cost of the medication. So if the total cost of the drug is $400/month, then before 12 months is up, you are going to pass the $3820 threshhold and fall into the donut hole. If the drug is $300 or less, then you wouldn’t fall into the gap unless you filled other medications later in the year that made you reach the $3820.

  1. Danielle Roberts is the BEST at explaining the details of Medicare. I highly recommend her and her team. Great video Danielle.

  2. The costs of some anti-cancer drugs are astronomical, even for their generic counterparts. At the present time, my medication is covered under Medicare Parts B and F. It is a generic drug but if I didn’t have Medicare Part F, I would have a copay of $830 every three weeks! I dread the thought of being switched to an anti-cancer drug covered under Part D due to the costs I would be responsible for in the Donut Hole.

  3. I will be enrolled for Medicare Parts A and B by Social Security Disability in Aug 2019. I will be 63 years old in May 2019. Will I have to pay the Part D late enrollment penalty if I wait until I turn 65 to buy a Part D policy?

    • No. At age 65 you get a “do over” and then receive retirement benefits rather than disability benefits. A better strategy is to buy the lowest premium part D when first eligible, not knowing what may be prescribed in the future, then checking Plan Finder each year at Annual Enrollment.

    • Lynda is exactly right. You only start gaining a late penalty for Part D if you don’t enroll after turning 65. If you have no other form of drug coverage currently, you should find a Part D plan that works for you now.

  4. I currently have my medigap coverage with another agency and would like to switch to Boomer Benefits for 2020 using the same plan. Is that possible?

  5. Is the $5100 out-of-pocket maximum to exit the gap include the total retail cost of the drugs or just my personal out-of pocket expense?

    • Yes on Part D in 2019, catastrophic coverage kicks in at $5100. If you spend that in a calendar year, then afterward the insurance carrier must pay 95% of the cost of your drugs for the rest of the year.

    • You are welcome! Just be sure to do the Medigap plans and NOT the Medicare Advantage plans. On many Advantage plans the chemo will cost you 20%. You want Medigap so that between Medicare and your plan, it’s covered 100%. I recommend Medigap for anyone that has had cancer.

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