The Medicare Donut Hole: What’s New for 2022

How does the Medicare donut hole work and when does it end?

所以甜甜圈孔恰好开始和结束2022年？简短的答案是，取决于第d部分计划you choose and how much you spend on prescription medications. Some people pay less for their medications when they enter the donut hole while others pay (usually only slightly) more.

Here are more facts about the Medicare donut hole.

Initial coverage limit

You enter the donut hole after you surpass the initial coverage limit of your Part D plan. The initial coverage limit includes the total (retail) cost of drugs — what both you and your plan pay for your prescriptions.

After surpassing this limit, you’ll need to pay a certain percentage yourself until you’ve reached what’s called the OOP threshold.

For 2022, the initial coverage limit has increased to4,430美元。This is up from $4,130 in 2021. Generally speaking, this means that you’ll be able to get more medications before you fall into the donut hole.

OOP阈值

This is the amount of OOP money that you have to spend before you exit the donut hole.

For 2022, the OOP threshold has increased to7,050美元。This is up from $6,550 in 2021, meaning that you’ll have to pay more OOP than before in order to get out of the donut hole.

When you’re in the donut hole, certain things count toward your total OOP cost to exit it. These include:

• OOP costs for generic and brand-name drugs while in the donut hole
• discounts on brand-name drugs while you’re in the donut hole, which includes a coverage gap discount plus a manufacturer discount
• your yearly deductible:$480in 2022, which is up from $445 in 2021
• any copayments or coinsurance

Extra Help considerations

Some people enrolled in Medicare qualify for the Medicare Extra Help program based on their income. This program helps people pay for their prescription drug costs.

If you get help from this program, you won’t enter the coverage gap or donut hole.

What are the rules about the Medicare donut hole for 2022?

最初，在甜甜圈洞中意味着您必须支付OOP，直到您达到更多药物报道的门槛。但是，自引入以来Affordable Care Act, the donut hole has been closing.

2022年有几种变化旨在限制您在覆盖范围内的口袋内成本。这些包括：

• 您将支付不超过25％的品牌药物价格。
• The nearly full price of the drug (more than what you pay out of pocket or 95 percent of its costs) will count toward getting you out of the coverage gap.
• You are responsible for a dispensing fee for your medicine. Your plan pays 75 percent while you pay 25 percent.
• The fees that don’t count toward your OOP spending include the 5 percent your plan pays plus the 75 percent toward the dispensing fee your plan pays.

当您在覆盖范围内，有些计划更深入的折扣。要仔细阅读您的计划是很重要的，以了解这是否适合您。

Let’s see how this works in some examples below.

Generic drugs

对于仿制药，只有你实际的金额向您的OOP阈值付费计数。例如：

1. You’re currently in the donut hole and a covered generic drug costs $40 and the dispensing fee is $2.
2. You’ll pay 25 percent of this cost OOP, which is $10. You’ll pay $0.50 for the dispensing fee.
3. 只有10.50美元的10.50美元将计入您退出甜甜圈洞的OOP成本。剩下的30美元不计数。

Brand-name drugs

For brand-name drugs,95 percent总用药价格将达到达到OOP阈值。这包括支付OOP加上制造商折扣的25％。

So, as a simple example:

1. 你在甜甜圈洞里，一个涵盖的名牌药物售价40美元。分配费为4美元。
2. You’ll pay 25 percent of this cost OOP, which is $10. You’ll also pay 25 percent of the dispensing fee or $1.
3. 制造商折扣将是70 percent或28美元。您的计划剩余5％或2美元。他们还支付75％或3美元的分配费用。
4. This totals to $39. This amount of money will count toward your OOP costs for getting out of the donut hole. The remaining $5 won’t count.

我退出甜甜圈洞后会发生什么？

退出甜甜圈洞后，您将收到所谓的灾难性覆盖范围。这意味着您必须支付今年剩余时间的任何东西：5％的药物成本或一小部分。

The minimum copay for 2022 has increased a little from 2021:

• Generic drugs:最低的抄送是$3.95, which is up from $3.70 in 2021
• Brand-name drugs:最低的抄送是$9.85, which is up from $9.20 in 2021

选择Medicare处方药覆盖率

Are you planning on注册in a Medicare prescription drug plan? Consider the following before choosing a plan:

• 使用Medicare网站to search for a plan that’s right for you.
• Compare a Medicare Part D with aMedicare Advantage (Part C)plan. Medicare Advantage plans include health care and drug coverage on one plan and sometimes other benefits like dental and vision.
• Check that the plan covers your medications.
• 如果你服用普通药物，请寻找收取低收量的计划。
• 如果您在甜甜圈洞中关注费用，请在此期间找到一个提供额外覆盖的计划。
• Make sure that additional coverage includes medications you take.

Understanding Medicare Part D

Medicare Part D是根据医疗保险的可选计划，以覆盖处方药。Medicare批准的保险提供者提供此覆盖范围。

Prior to Part D, many people received prescription drug coverage through their employer or a private plan. For those who purchase a basic Part D plan in 2022, the estimated average monthly premium isestimated to be $33。这一平均水平略高于2021年的平均每月溢价为31.47美元。

Both brand-name and generic drugs are涵盖Medicare D部分plans. At least two drugs in commonly prescribed drug categories are included on the list of covered medications, which is called a formulary.

However, the specific drugs covered in your Part D plan can vary from year to year. Your provider can make changes to its formulary throughout the year, as long as it follows certain guideline. This can include things like changing brand-name drugs to generic ones.

Tips for helping a loved one enroll in Medicare

Maybe you’re too young forMedicare，但你帮助了一个人的注册。以下是一些考虑因素：

• 知道他们是否收集社会保障福利。如果是，如果符合条件，他们会自动注册A和B部分。如果没有，他们可以sign up for Medicare在65岁生日开始3个月。
• Be aware of their individual needs.他们经常去看医生，服用几种药物，还是需要额外的愿景或牙科护理？知道这些事情可以提供帮助select an appropriate plan。
• 准备提供有关您自己的个人信息。Social Security may ask about you and your relationship to the person you’re helping. Your loved one will need to sign the Medicare application when it’s complete.

6 ways to reduce Medicare prescription costs

Is there anything else that can help reduce the cost of prescription medications? Here are six suggestions:

1.考虑切换到通用药物。

These are oftenless expensivethan brand-name drugs. If you’re taking a brand-name drug, ask your doctor about generic drugs.

2. Think about ordering medications online.

在某些情况下，这可能更具成本效益。FDA有一个 提示清单 为了安全地在线购买药物。

3.在甜甜圈孔期间选择具有额外覆盖的计划。

Some Medicare plans may provide additional coverage while you’re in the donut hole. However, you may be subject to higher premiums.

4.调查国家制药援助计划。

Many states offer programs that can help with the cost of your prescriptions. Medicare has asearch toolto find programs in your state.

5.检查药品援助方案。

许多制药公司为需要帮助其药物成本的人提供援助计划。

6.申请Medicare额外帮助。

Individuals that have Medicare drug coverage and have limited income and resources may qualify for the Medicare Extra Help program. This helps to pay for premiums, deductibles, and copayments associated with a Medicare drug plan.

外带

Medicare甜甜圈孔是计划D处方覆盖范围的覆盖范围。您通过了初始覆盖范围后输入它。

In 2022, you’ll have to pay 25 percent OOP from the time you enter the donut hole until you reach the OOP threshold.

There are a variety of things that you can do to help bring down the cost of prescriptions. These include switching to generic dugs, having extra coverage for the donut hole, or using an assistance program.

When selecting a Medicare prescription drug plan, verify that a plan covers your medications. It’s always a good idea to compare multiple plans to find the one that’s right for your individual needs.