Critter Corner: What’s the Deal with the Donut Hole in 2022?

Dear Angel,

This year, the 2022 Medicare and You handbook didn’t include all the information regarding the Medicare Part D deductibles and the “Donut Hole.” What am I missing? Thanks for your help!

Missy Ing-Infoe

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Dear Missy,

You are correct that the 2022 Medicare and You handbook did leave information out regarding the 2022 Medicare Donut Hole, including Part D deductibles or out of pocket maximums. Luckily, I can provide information on what the Medicare Part D cost, copays, and Donut Hole out of pocket will be beginning January 1, 2022.

Part D changes for 2021 are:

– Initial Deductible will increase by $35 from $445 in 2021 to $480 in 2022.

– Initial Coverage Limit will increase by $300 from $4,130 in 2021 to $4,430 in 2022, which is where the 2022 “Donut Hole” begins.

– Out-of-Pocket threshold cost will increase from $6,550 in 2021 to $7,050 in 2022.

– Coverage Gap (Donut Hole): begins once you reach your Medicare Part D plan’s initial coverage limit $4,430 in 2022 and ends when you spend a total of $7,050 out-of-pocket in 2022.

What is the Donut Hole Discount?

Part D enrollees will receive a 75% Donut Hole discount on the total cost of their brand-name drugs purchased while in the Donut Hole. The discount includes a 70% discount paid by the brand-name drug manufacturer and a 5% discount paid by your Medicare Part D plan. The 70% paid by the drug manufacturer and 5% Part D plan discount combined with the 25% you pay both count toward your Donut Hole exit point.

Remember you will pay 100% of the cost if any prescriptions (generic or brand name) not
covered under your Medicare Part D plan.

Also, don’t forget . . . there is a penalty for not enrolling in a Medicare Part D Prescription Drug plan when you first become eligible to enroll, so be sure to do so.

Hope this helps,
Angel

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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