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July 2016
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Obamacare: Will the Medicare Part D “Donut Hole” Make a Comeback?

We’ve been getting a lot of questions lately about what’s going to happen to the Affordable Care Act (or “Obamacare”): Is the Supreme Court going to strike it down? What is the debate doing to Obama’s chances of being re-elected? And what’s going to happen to my health insurance?

Well, the honest answer is: We don’t know. There are a thousand different possible scenarios that could play out, and it’s still too early to venture any good guesses. But we do know one thing that many seniors and their families should start thinking about in the event that Obamacare is struck down, and we start at ground zero again: the Medicare Part D “donut hole.”

If you remember, one of the main objectives of the Affordable Care Act has been to close the Medicare Part D “donut hole,” the coverage gap which limits how much Medicare Part D will cover for prescription drugs. Currently, the Medicare Part D coverage gap starts when you hit $2,930 in prescription drug costs. Medicare Part D coverage picks up again once you hit $6,657 in drug costs.

In between those two points, you’re in the “donut hole.” Pre-Obamacare, seniors were usually stuck trying to cover the entire prescription drug coverage on their own, but Obamacare closes that gap over the next few years. Currently under Obamacare, Medicare Part D plan members receive a 50% discount on their brand name drugs while they are in the “donut hole.” Generic prescription drugs are discounted in the Medicare Part D “donut hole” as well. In 2012, generic drugs are discounted 14% in the “donut hole.”

If Obamacare entirely goes away, it looks like seniors will be going back to having to pick up the full costs of the “donut hole” again, so no discounts on either generic or brand name prescription drugs. That means that if you’re at or past the $2,930 in prescription drug costs for the year, be prepared to have to pay in full for the rest of your prescription drugs until you hit the $6,657. Ouch!

Are you prepared for the Medicare Part D “donut hole” to make a comeback? Tell us about it in our prescription drug forum!

Join the forum discussion on this post

Related posts:

  1. How Far Are You Into the Medicare Part D Prescription Drug “Donut Hole”?
  2. Halfway Through the Year! How Far Are You Into the Medicare Part D “Donut Hole”?
  3. Are You in the Medicare Part D “Donut Hole” Yet?
  4. Medicare Donut Hole: Are Generics Really Always the Cheapest Drugs?
  5. Open Enrollment: the Medicare Part D “Donut Hole” Review

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