Medicare Part D Coverage Gap (Donut Hole)
🍩 What is the Coverage Gap?
The Medicare Part D "donut hole" is a temporary gap in prescription drug coverage. After you and your plan have spent a certain amount on drugs, you enter this phase where you pay more out of pocket — until you reach catastrophic coverage.
2026 Part D Coverage Stages
Stage 1: Deductible
You pay 100% of drug costs until you meet your plan's deductible.
2026 maximum deductible: $590
Stage 2: Initial Coverage
You pay copays or coinsurance, your plan pays the rest.
Until total drug costs reach: $5,030
Stage 3: Coverage Gap (Donut Hole)
You pay 25% for brand-name drugs and 25% for generics until you qualify for catastrophic coverage.
Note: In 2025, the donut hole was effectively closed for most beneficiaries
Stage 4: Catastrophic Coverage
You pay a small coinsurance for the rest of the year.
Begins after: $8,000 true out-of-pocket costs
What Counts Toward the Gap?
✓ Counts
- • Your deductible payments
- • Your copays and coinsurance
- • What your plan pays
- • Manufacturer discounts
✗ Doesn't Count
- • Your monthly premium
- • Pharmacy dispensing fees
- • Drugs not covered by your plan
- • Drugs from non-network pharmacies
How to Reduce Costs in the Gap
Apply for Extra Help (LIS)
If you qualify, Extra Help pays most of your Part D costs, including during the gap.
Learn more about Extra Help →Ask About Generic Alternatives
Generic drugs often cost much less. Ask your doctor if a generic would work for you.
Check Patient Assistance Programs
Many drug manufacturers offer programs to help cover costs for people who qualify.
Compare Plans During Open Enrollment
Different plans cover different drugs at different prices. Review your options each year.
💊 Track Your Drug Spending
Log into Medicare.gov to see where you are in your coverage stages:
- 1. Go to Medicare.gov and log in
- 2. Click on "Drug Coverage (Part D)"
- 3. View your spending summary