What does the term "donut hole" with insurances mean?

Question

I have someone who went to fill a prescription and was told he had to pay the full amount of $200.00 because he had a "donut hole" situation. Please explain. I could not and I'm usually pretty good with insurance issues.

Answer 1

Look at a doughnut.....it's a ZERO.  It's just a slang term meaning "zero," "nothing," etc....no coverage in this case.  If you play the lottery you'll end up with a "doughnut hole".....nothing....

Answer 2

It isn't a real insurance term, but it means either the insurance doesn't cover that medicine, or he has a high deductible - it's a "hole" in his coverage.

Answer 3

It means the patient has to pay the full cost of their medication until they meet their deductible again...once that deductible is met, their copays will drop significantly but only for a certain amount of time....

most Medicare plans have donut holes....which sadly affects older patients and leads them to not take their medications because its so expensive...