Member: I’ve been told my prescription drug coverage might reach the “donut hole” stage this year and that I’ll be paying more. Why is there a donut hole and is there a way to avoid it? —Darlene, Inver Grove Heights
Anita: Thank you for the question, Darlene. Many people have asked about the “donut hole,” also known as the coverage gap stage of a Medicare Part D drug plan. The donut hole is the third of four coverage stages:
Stage 1 Deductible stage — You pay the full cost of your drugs until you reach your deductible.
Stage 2 Initial coverage stage — Once your deductible amount is met, you begin sharing costs with your health plan, either through a copay or coinsurance.
Stage 3 “Donut hole” or coverage gap stage — This begins when the total cost of your prescription drugs reaches $4,430, and you have to pay 25 percent for both generic and branded medications.
Stage 4 Catastrophic coverage stage — If your out-of-pocket costs reach $7,050, your share of the cost drops to a minimal amount. You remain here through the end of the calendar year.
The donut hole is the stage where you as the consumer must pay a little bit more for your medications. This is meant to incentivize people to use generic drugs and to be more mindful about their medications in general.
It’s preferable to avoid the coverage gap stage if you can. The best way to do that is to make sure your health plan is the best fit for your medication needs. Blue Cross has a variety of plans with Part D coverage that could be a good fit for you.
Second, be mindful of the medications you are taking. Talk to your doctor about whether generic drugs might be a good substitute for more expensive brand-name drugs. You can also arrange a Comprehensive Medication Review with your pharmacist or a Blue Cross pharmacist to get a better handle on all your medications, potential interactions and side effects. Call 1-866-873-5941, Monday through Friday, 9 a.m. to 5 p.m. Or send us an email at BCBSMN.Medicare.CMR@bluecrossmn.com to learn more.
To learn more about prescription drug costs, log into your Blue Cross member website at bluecrossmnonline.com and click on the “Prescriptions” tab. Then click on the “Costs and Savings” icon. This will take you to myprime.com, where you can search benefits and costs specific to your plan.
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