• Tel (781) 344-2886
  • Email info@brc-law.com

Law Offices of Barry R. Crimmins

Barry Crimmins

  • Practice Areas
  • Firm Overview
    • News
  • Current Projects
  • Blog
  • Contact Us
    • Stoughton, MA
    • Hyannis, MA
    • Falmouth, MA
Slide background
Legal Expertise, Personally.
Attorney Barry R. Crimmins is someone that you can depend on personally.
We take a small town approach to our client relationships and carry that personal
commitment into all of our cases.
Slide background
Life Happens. We Help You Plan For It.
The many stages of life present a variety of legal implications. Guidance on
Estate Planning and Administration, Medicaid and Elder Law issues are our focus.
Slide background
Real Estate Transactions, Permitting and
Development.
Whether commercial or residential, we have extensive experience in all aspects
of real estate law.

How You Can End Up in Medicare’s Donut Hole, and How You Get Out

May 18, 2021 By Barry Crimmins

Medicare prescription drug (Part D) plans can have a coverage gap—called the “donut hole”–which limits how much Medicare will pay for your drugs until you pay a certain amount out of pocket. Although the gap has gotten much smaller since Medicare Part D was introduced in 2006, there still may be a difference in what you pay during your initial coverage compared to what you might pay while caught in the coverage gap. 

When you first sign up for a Medicare prescription drug plan, you will have to pay a deductible, which can’t be more than $445 (in 2021). Once you’ve paid the deductible, you still need to cover your co-insurance (also called co-payment) amount (depending on your drug plan), but Medicare will pay the rest. Co-insurance is usually a percentage (for example, 20 percent) of the cost of the drug. If you pay co-insurance, these amounts may vary throughout the year due to changes in the drug’s total cost. 

Once you and your plan pay a total of $4,130 (in 2021) in a year, you enter the coverage gap, aka the notorious donut hole. Previously coverage stopped completely at this point until total out-of-pocket spending reached a certain amount. However, the Affordable Care Act has mostly eliminated the donut hole. In 2021, until your total out-of-pocket spending reaches $6,550, you’ll pay 25 percent for brand-name and generic drugs. Once total spending for your covered drugs exceeds $6,550 (the “catastrophic coverage” threshold for 2021), you are out of the coverage gap and you will pay only a small co-insurance amount. For more from Medicare on coinsurance drug payments, click here.  

Once you are in the coverage gap, your yearly deductible and co-insurance payments count toward the amount you need to pay to reach catastrophic coverage. The amount of out-of-pocket costs that you have to pay to reach catastrophic coverage will vary, depending on the type of drugs you take. In the case of brand name drugs, you will pay only a certain percentage of the price, but the entire price will count toward the amount you need to qualify for catastrophic coverage. With generic drugs, only the amount you pay will count toward getting you out of the donut hole. For more information about the coverage gap, click here.  

Bear in mind that only payments for drugs that are covered by your plan count towards the out-of-pocket threshold. Your premium and the portion of the drug cost that Medicare pays do not count toward reaching catastrophic coverage, either. Also, any help with paying for Medicare Part D costs that you receive from an employer health plan or other insurance does not count toward this limit. 

For more information about Medicare’s prescription drug benefit, click here.

 

Filed Under: blogs

Contact Us Today

  • We are happy to discuss any legal concerns with you.
  • This field is for validation purposes and should be left unchanged.
Communication of information through this website does not create an attorney-client relationship.

Recent Posts

march newsletter

Elder Law News, March 2023

As the generation of Baby Boomers ages, many are finding their adult children aren’t in the financial position to provide support if long-term care is needed.

BRC Newsletter March

Elder Law News, September 2022

As the generation of Baby Boomers ages, many are finding their adult children aren’t in the financial position to provide support if long-term care is needed.

august newsletter

Elder Law News, August 2022

With healthcare and nursing homes being a hot topic as of late, you may have some questions regarding your care or the care of a loved one. If so…

Elder Law News - May 2022 Thumbnail

Elder Law News, May 2022

With healthcare and nursing homes being a hot topic as of late, you may have some questions regarding your care or the care of a loved one. If so…

Elder Law NEWS - April 2022

Elder Law News, April 2022

In 2022, change remains constant. But, as it applies to eldercare, some shifts are favorable, while others could directly impact the financial stability and level of care your loved one receives. 

Our expertise includes Real Estate Law and Land Use Permitting, Estate Planning and Estate Administration, with an emphasis on Elder Law and Medicaid Planning.
Practice Areas
We've developed a reputation for excellent service in these areas of the law through more than 35 years of experience.
Our Attorneys
The legal services from the Law Offices of Barry R. Crimmins, P.C. in Stoughton, Falmouth and Hyannis Massachusetts
Our Locations

Recent News

Law Offices of Barry R. Crimmins, PC

march newsletter

Elder Law News, March 2023

As the generation of Baby Boomers ages, many are finding their adult children aren’t in the financial position to provide support if long-term care is needed.

BRC Newsletter March

Elder Law News, September 2022

As the generation of Baby Boomers ages, many are finding their adult children aren’t in the financial position to provide support if long-term care is needed.

august newsletter

Elder Law News, August 2022

With healthcare and nursing homes being a hot topic as of late, you may have some questions regarding your care or the care of a loved one. If so…

Elder Law News - May 2022 Thumbnail

Elder Law News, May 2022

With healthcare and nursing homes being a hot topic as of late, you may have some questions regarding your care or the care of a loved one. If so…

Elder Law NEWS - April 2022

Elder Law News, April 2022

In 2022, change remains constant. But, as it applies to eldercare, some shifts are favorable, while others could directly impact the financial stability and level of care your loved one receives. 

Links

  • Home
  • News
  • Site map
  • Privacy Policy
  • Terms & Conditions

Contact Us

  • 909 Washington Street, Stoughton, MA 02072
  • 1436 Iyannough Road, Hyannis, MA 02601
  • 20 Academy Lane, Falmouth, MA 02540
  • Phone: (781) 344-2886
  • Email: info@brc-law.com

Follow Us:

  • facebook
  • twitter
  • linkedin

Estate Planning

  • Estate Planning
  • Estate Administration
  • Elder Law
  • Medicaid Planning

Real Estate

  • Land Use Permitting
  • Landlord – Tenant
  • Purchase & Sale Agreements
© Copyright 2023 Law Offices of Barry R. Crimmins, P.C. All rights reserved.
Site Maintained by Interactive Palette