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Explore: The Closing Donut Hole

The Closing Donut Hole

The Closing Donut Hole

If you haven’t been really, really sick in the last few years, you may not have ever heard of the “donut hole” in Medicare Part D prescription drug plans.  This is the common name in the medical field for a quirky coverage gap where, if you incurred $3,750 worth of drug costs in any given year, you would suddenly be paying for a significant portion of your drug expenses out-of-pocket.  Last year, patients who breached that threshold would have to pay 35% of the cost of brand-name drugs and 44% of generic drugs until their out-of-pocket spending reached $5,000.  After that, they would pay no more than 5% of their drug costs for the rest of the year.  Of course, not everybody knew about the donut hole until they suddenly had to pay a significant fraction of the high cost of rare prescription drugs, and their expenses skyrocketed.

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