What is the “Doughnut hole” in Part D Medicare coverage, and how does it work?
The Medicare Part D “doughnut hole” was a coverage gap that existed until 2024, where beneficiaries faced higher out-of-pocket costs for prescriptions after reaching certain spending thresholds. During the gap phase, people paid significantly more for their medications until they qualified for catastrophic coverage. The coverage gap was gradually reduced through the Affordable Care Act […]
What if I need a drug that isn’t on the Medicare Formulary or costs too much?
If your physician determines that you need a drug that is not on a Part D plans formulary, they can ask the insurance company for an exception. However, there are rarely drugs that are not on the formulary that an insurance plan will grant an exception for. In most cases, these are experimental drugs that […]