Most Medicare Part D drug plans have a coverage gap—also known as the “donut hole”—that limits what the drug plan will cover after you’ve reached your initial coverage limit.
The 2019 standard initial coverage limit is $3,8202. Once you and your plan spend more than $3,820 on covered drugs, you’re in the donut hole coverage gap until your out-of-pocket costs reach $5,100.
What do you need to do?
In the coverage gap: You'll need to pay your premiums and out-of-pocket drug costs from the time you meet your deductible (if your plan has one) until you reach catastrophic coverage. If you have a Medicare prescription drug plan that includes coverage in the gap, you may get a discount after your plan's coverage has been applied to the drug price. The discount for brand-name drugs will apply to the remaining amount you owe.
After the coverage gap: Once your costs exceed the coverage gap ($5,100 in 2019), you’ll be in catastrophic coverage and responsible for 5% of your prescription drug costs for the rest of the year.
Good news! Walgreens provides discounted prescriptions for Part D recipients in the donut hole coverage gap.