Medicare Part D
Medicare Part D covers prescription drugs. The Affordable Care Act has changed Medicare Part D to increase what Medicare pays and lower what you pay. Another change is that the coverage gap -- or 'donut hole' -- will be closed by 2020.
The 'donut hole' refers to the gap in coverage when you were required to pay 100% of the cost. This typically happened when your drug costs reached $2,831 and lasted until you spent $6,440. This affects about 4 million seniors.
The new law will close the 'donut hole' by 2020.
2010
Last year you received a $250 rebate check in the mail if:
- You fell into the gap, and
- You did not receive any other help paying for your prescriptions through programs such as Medicare Extra Help
2011
In 2011, while in the gap you pay:
- 50% of the cost of brand-name prescription drugs
- 93% of the cost of generic drugs
Between 2012 and 2020
Every year, after you play your deductible, you will spend less before Medicare coverage kicks back in.
| Year | % You Pay for Brand-Name Drugs | % You Pay for Generic Drugs |
| 2012 | 50 | 86 |
| 2013 | 47.5 | 79 |
| 2014 | 47.5 | 72 |
| 2015 | 45 | 65 |
| 2016 | 45 | 58 |
| 2017 | 40 | 51 |
| 2018 | 35 | 44 |
| 2019 | 30 | 37 |
| 2020 | 25 | 25 |
In 2020, you will pay only 25% of all your drug costs. Medicare will pay the difference. That means after you pay your deductible, you will pay only 25% of the cost for prescription drugs up to $6,400. Medicare will pay all costs after that.