The Donut Hole: Entering the Prescription Drug Plan Gap


“Donut hole” is the nickname for the period when your retail drug costs for your prescription drugs exceeds $3,310 (2016). Once you have arrived at the Part D coverage gap and become responsible for paying the next $4,850 in prescription drug cost, you have reached the donut hole.

Under the Affordable Care Act, seniors receive some assistance with payments in the donut hole (Closing the Doughnut Hole Chart). Currently, seniors are responsible for paying 45% of the cost of brand name prescriptions. Generic drugs are paid at 58% discount. Once you reach the $4,850 limit, you are responsible for a nominal amount of the cost (5% co-insurance or a $2.60 copay for generic drugs).