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Donut Hole Discount, Coverage Gap? How much money can be saved in 2017

Depending on the Medicare Part D plan you have, the savings could be about $2,450 or even more.

This  savings in the 2017 Donut Hole Discount will depend on several different things:

  1. How much you personally spent prior to reaching the Donut Hole
  2. How much did you spend on drugs, generic vs. brand name medications while you’re in the Donut Hole for 2017, keeping in mind while you’re in the 2017 Donut Hole generic drugs you receive a 49% discount and for name brand drugs 60%. Also you only receive a 90% credit of brand name drugs purchasing cost that go toward your out of pocket threshold limit (TrOOP) of $4,950 for 2017. That 90% also includes the 50% discount which is paid by the manufacturer of the brand name drug, then you pay 40%. Medicare Part D plan 10% discount will not be counted towards TrOOP.

Here are some examples that are assuming:

  1. There is an initial $400 Deductible on your Medicare Part D Plan
  2. Your plan includes a co-insurance cost sharing structure; a standard 25%, meaning this 25% you pay, and 75% the other pays.
  3. While in the Donut Hole, you only purchase brand name medications.
  4. You meet the out of pocket $4,950 out of pocket threshold (TrOOP) by spending you’re through your entire Coverage Gap and or Donut Hole.

So the amount that could be saved is around 60% of $4,097.50, about $2,458.50 saving to you.