Can You Avoid The Part D Donut Hole?

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The infamous Part D Donut Hole is the portion of Part D in which your coverage lapses. When you and your insurance carrier collectively pay $4,130, you are responsible for paying 25% of the cost of every medication you need from that point. Once you and your plan have paid $6,550, you are again covered and only have to pay 5% of the cost of the drug. If your medications are expensive, 25% can quickly add up. Learn how to avoid the Part D donut hole below. 

Keep Costs Low

The best way to avoid the Part D Donut Hole is by never hitting it in the first place. This means keeping your medication costs low. Remember, the costs to both you and the insurance carrier count towards the $4,130, so you need to keep costs low for the insurer as well. There are multiple ways to do this. The easiest way is to buy generic prescriptions when possible. Many medications work the same whether they are generic or brand name, but the generic version will save both you and the insurance company money. You can also save money by buying your prescriptions through the mail and in advance. Lastly, you can choose a Part D plan that covers your particular prescriptions better. Many insurers have made deals with different pharmacies and manufacturers. You can use the Medicare website to compare Part D plans based on the cost of specific prescriptions to decrease your costs. 

Get Financial Assistance

If you cannot avoid the donut by decreasing your costs, you can try to see if you qualify for financial assistance to help cover your costs. Specifically, you can apply for Extra Help or Medicaid.

Extra Help

The Extra Help Program offers financial assistance to people with a limited income so that they can afford Part D. To be eligible, you must be enrolled in Medicare, live in the 50 U.S. states and Washington, D.C., and have a limited income (up to $29,160 in combined savings, investments, and real estate if married, $14,610 if unmarried). 


You can also apply for Medicaid. Medicaid is a financial assistance program for people with low incomes as designated by their states. It helps pay for healthcare costs. You can have both Medicare and Medicaid at the same time. Specific requirements depend on the state. 

To learn more about how to avoid the Part D donut hole or how to cover your costs when you find yourself there, contact us at Bobby Brock Insurance today. 

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Justin Brock

President & CEO of Bobby Brock Insurance