Technically the “donut hole” will be completely phased out for 2020. In 2020, patients will not pay more than 25% of their drug costs during the coverage gap / donut hole for both brand-name and generic medications. A 25% coinsurance is equivalent to the maximum amount a patient could pay during initial coverage, prior to reaching the coverage gap. 

However, beginning in 2020 the true out-of-pocket (TrOOP) threshold is increasing significantly to $6,350, which is over a $1,000 increase compared to 2019. This means patients will remain in the coverage gap ("donut hole") for a much longer period of time before they transition to catastrophic coverage where their copays are minimal. 

What's Next?

Click here to learn more about the different phases of coverage!

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