Last with the Part D donut hole

the part d donut holePart D prescription drug plans were first introduced in 2006 and the Part D Medicare donut hole first began.  I remember this because of 2 things. I have been an insurance broker for over 18 years.  When I first started selling Medicare Supplements, I learned from my Mom Kathleen. She was selling Medicare Supplements and final expense back in the early 80’s. Hi I’m  Mitch Winstead with Allstar Senior Benefits. Our website is   We offer free advice. If you have any questions or would like a quote, please call us toll-free at 866-598-8170 or 910-538-4547 or 910-452-1922.  If you would like a quote with no obligations, please click this link  Our email address is  We have a facebook page at   Here are the 2 things I remember back in the day.  1. Back in the year 2000, there were plans with the alphabet letters- H, I and J at that time.  Those plans would actually cover prescriptions. These plans would have a $250 deductible and they would pay half your cost of your medicines. 2. Why I remember the part D program so well is- whenever I talk to people about their Medicare supplements, they would always ask me does this cover any medicines.

Medicare aged 65 and over

A senior couple on holiday at the seaside.

What I would tell clients is that the plans mentioned already- H, I, and J would cover medicine.  Back in the year 2006, they stopped carrying those plans because the Part D prescription drug plan started. I am glad they started the Part D plans but it’s not a perfect solution. Besides the premiums, there are co-pays, coinsurance, and deductibles on most plans that are sold today. There are a lot of moving pieces in a Medicare Part D prescription drug plan. Sometimes, the Part D plan does not cover the medicine you’re taking.  Also, the plan might not cover a medicine that is prescribed by the doctor.  In some cases, the insurance company may want you to start out on a generic drug or another medicine to see if that helps first before paying for a more expensive medicine. The companies that sell Part D prescription drug plans are private insurance companies. There are no health questions. it is just a matter of finding the best plan that works for you at the lowest rate.


So with paying a premium, having a copay, paying for coinsurance and the Part D plan would only cover the cost of so many medicines. In other words, there is a monetary cap each year.  Part D Medicare plans have higher deductibles lately as much as $450.00. The deductible adds more money the consumer has to pay for Part D coverage.  On top of that, you have to deal with what’s called the “donut hole”. That means if you get to a certain dollar amount on your plan, the coverage for your part D takes a not so good turn for the worse.  This means the “donut hole” So let’s fast forward to today’s cap for going into the “donut hole.” Part D plans for 2018 will cover $3750.00 as a monetary cap. That means after that dollar amount is met you will pay a higher amount for your medicines until you reach your point of $5,000- that is called catastrophic coverage. The good news is that the insurance company at that point have to cover 95% of the cost of your covered medications for the rest of the year.


Under the new budget deal for 2018, the plans will continue to pay 75% of the brand name drug expenses until a beneficiary reaches the catastrophic limit. The legislation thus figuratively closes the donut hole to by requiring some drug manufacturer to bear more of the cost for Part D and enrollees when they reach the gap. Enrollees will only pay 25% of the cost of their brand-name prescriptions.  Generic medicines will be 37% but traditionally generic drugs, which already have lower costs, have not been the hardship for people in the cap.


In 2018 these manufacturers pay 50% of the cost of these brand name medications in the gap. Beginning in 2019 under the new legislation, these companies will now take on 70% and now some of the cost of those drugs has shifted back to the manufacturer,


We’ll have to see how this change might affect the cost of the medication themselves and the cost of the part D drug plans in 2019. It is hopeful that this change will be a positive one. We think many clients will be happy that the donut hole is finally going away.


This bill also repeals caps on Rehab Services. Since I have a license in physical therapy and co-own a Physical Therapy practice, I can speak to this subject very well. This means that there is no longer a Part B therapy cap on Medicare recipients.

Physical Therapy treatments

Physical Therapist working with a woman on an exercise mat

Under the old therapy cap, people using Part B benefits were “capped” at $3750. Rahab companies would have to stop giving people therapy services such as physical therapy, occupational therapy, and speech therapy.   If we were treating a patient and the patient still needed therapy, we would have to stop providing services until that cap reset for the coming new year. Another part of the new legislation means this will also expand Medicare’s ability to offer telemedicine services. It also does away with the independent payment advisory Board sometimes called the “death panel” created by the Affordable Care Act. Medicare Advantage plans got welcome news also. Now they will offer a wider choice of supplemental care management options for chronically ill individuals.  To help fund the budget deal, high-income Medicare beneficiaries earning more than $500,000 individually or $750,000 as a married couple will have to pay more for Parts B & D then they do now.   All of our plans and policies are state approved and regulated. We offer free advice with no obligations. Our toll-free number is 866-598-8170 or 910-538-4547 or 910-452-1922. If you would like a quote with no obligations, please click here

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