According to CMS, the number of Medicare beneficiaries receiving preventive care services with little or 

no cost sharing, and the number of seniors benefitting from the incremental closing of the Medicare 

Part D “donut hole” increased in 2012. The report entitled The Affordable Care Act – A Stronger 

Medicare Program in 2012 cites these benefits as stemming from reforms made under the Affordable 

Care Act (ACA). Among these reforms are increased discounts to beneficiaries who pay for prescription 

medications while they are in the “donut hole” and elimination of coinsurance and the Part B deductible 

for recommended preventive services. In 2012, 34.1 million Medicare beneficiaries used at least one 

free preventive service and 3.5 million beneficiaries reached the donut hole and received a discount on 

their prescription medication costs averaging $706 per beneficiary.
 

In 2012, the ACA provided that a beneficiary would pay 86 percent of the cost of generic medication in 

the donut hole and the full price for brand name drugs. Each year until 2020, the ACA requires that 

these percentages are decreased until the beneficiary is paying 25 percent of the cost for both generic 

and brand name drugs. Since the ACA’s enactment, 6.1 million beneficiaries have saved $5.7 billion on 

prescription medications: $2.3 billion in 2011 and $2.5 billion in 2012. CMS noted that most of the 

savings were for drugs that treat chronic conditions, suggesting that beneficiaries who must 

continuously take medication are benefiting the most from the ACA’s gradual elimination of the donut 

hole.
 

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827