What is the Prescription Drug Coverage Gap?

The prescription drug coverage gap, commonly known as the "donut hole," is a temporary limit on what Medicare Part D plans cover for prescription drugs. After you and your plan spend a certain amount on covered drugs, you enter the coverage gap where you pay a higher percentage of costs until reaching catastrophic coverage. The Affordable Care Act has been gradually closing this gap, with full closure scheduled by 2025.

Why the prescription drug coverage gap matters

• Increases medication costs: Results in higher out-of-pocket expenses during the gap period
• Affects medication adherence: May cause beneficiaries to skip doses or stop medications
• Requires financial planning: Necessitates budgeting for higher drug costs during gap months

How Solace can help

A Solace advocate can help you understand your Part D coverage phases, explore ways to minimize costs during the coverage gap, and identify assistance programs for expensive medications. Advocates can also help you plan for annual drug expenses and compare Part D plans during enrollment.