What Is the Medicare Donut Hole or Coverage Gap?

The Medicare coverage gap or "donut hole" refers to a period when there is a limit on prescription drug coverage . It begins once the Medicare Advantage plan and member spend $4,430 ($4,660 in 2023) on covered drugs. During this time, members are responsible for up to 25% of the cost of brand name and generic drugs. Some plans offer additional coverage in the gap, such as $0 copays on preferred brand name drugs and generics. The gap ends once the member spends $7,050 ($7,400 in 2023) on covered drugs.

What Is the Highest-Rated Medicare Advantage Plan?

Kaiser Permanente’s 2023 Medicare Advantage plans with drug coverage all receive five stars from the Centers for Medicare and Medicaid Services (CMS). The CMS ranks Medicare Advantage and prescription drug plans on a five-star scale, from one to five stars, with five stars being the highest or best rating. A plan’s star rating reflects its performance, based on the experiences of the people enrolled in the plans.

What Is the Biggest Disadvantage of Medicare Advantage?

One of the main drawbacks to Medicare Advantage plans is that they typically have dedicated networks, such as an HMO or PPO. With Original Medicare you aren’t restricted to a network, and can choose any provider that accepts Medicare.

Can I Drop my Medicare Advantage Plan and Go Back to Original Medicare?

Yes, but you must do it during one of the open enrollment periods. You can switch back to Original Medicare during the annual Medicare Open Enrollment period from October 15 to December 7. Your new coverage will go into effect January 1. Or, you can switch during Medicare Advantage Open Enrollment from January 1 to March 31. Your new coverage will go into effect on the first day of the month after you ask to join the plan. If you return to Original Medicare, consider buying a Medicare supplement (Medigap) plan during open enrollment.

Health Insurance

Best Medicare Advantage Plans 2023

UnitedHealthcare offers nationwide coverage with happy customers and $0 copays

Meredith Mangan

Updated March 09, 2023

Reviewed by

Samantha Silberstein

Fact checked by

Matthew M Klammer

We independently evaluate all recommended products and services. If you click on links we provide, we may receive compensation. Learn more.

Medicare Advantage (MA) plans offer benefits that Original Medicare does not, such as an annual limit on out-of-pocket expenses and coverage for dental, vision, and hearing care. In exchange (and unlike Original Medicare), you generally need to use in-network providers and services. But since MA plans are administered by commercial insurance companies, costs and benefits differ, making it essential to shop around.

We evaluated Medicare insurance companies based on key factors in the following categories and weighed them accordingly: plan quality and quality of care (30%), plan value (20%), additional drug coverage in the Medicare gap (15%), state availability (15%), extra plan benefits and perks (10%), available plan types (5%), and whether special needs plans (SNPs) are available (5%).

AARP / UnitedHealthcare

Investopedia's Rating

4.7

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Pros & Cons

Pros

Available in most states and Washington D.C.
Largest provider network nationwide
Offers additional drug coverage in the gap
UHC “HouseCalls”
$0 PCP, specialist, and lab copays

Cons

Ranks one point below the industry average for customer satisfaction

Why We Chose It

AARP's UHC plans have high NCQA and Medicare star ratings, the largest provider network of all MA plan providers, and a broad array of managed networks and plan options to choose from.

Overview

UnitedHealthcare (UHC) is the largest provider of Medicare Advantage plans in 2023, capturing 28% of the Medicare Advantage market in 2022. This might be because UnitedHealthcare’s MA plans—co-branded with AARP—earn high marks for plan quality and member experience. On average, UHC Medicare Advantage plans with drug coverage have a 4.2 Medicare star rating, which is above the national average of 3.97. They also have a nearly 4-star average rating from the National Committee for Quality Assurance (NCQA), which is the second-highest rating among the largest MA providers nationwide. Both organizations score on a five-star scale.

The company offers a range of plan types, including HMO, PPO, and PFFS plans. Coverage is available for vision, hearing, and dental care; non-emergency transportation; and worldwide emergencies. Plus, UHC offers its HouseCalls program, which provides annual no-cost in-home care visits. And most plans offer additional drug coverage during the Medicare donut hole, which can save money if your drugs cost more than $4,660 in 2023.

Though UHC outperforms its peers in key metrics, it ranked one point below the industry average in the J.D. Power 2022 U.S. Medicare Advantage Study, which puts it fourth out of the nine largest providers for overall customer satisfaction.Also, the average plan limit on out-of-pocket expenses is $5,299 in 2023, which is higher than some competitors but slightly lower than the average across major insurers.

Read more in our UnitedHealthcare Medicare review.

Aetna

Investopedia's Rating

4.7

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Pros & Cons

Pros

Offers additional drug coverage in the gap
Well-priced plans
Concierge service
Home health visits with all MA plans
$0 PCP and specialist copays
Better-than-average Medicare star rating

Cons

MA plans unavailable in Alaska, Hawaii, Minnesota, Montana, and Vermont
No PFFS MA plans

Why We Chose It

Aetna offers more plans with additional drug coverage in the Medicare donut hole than any of the largest MA plan providers nationwide, making it an excellent choice if you spend a lot on prescription drugs.

Overview

More of Aetna's plans offer additional drug coverage in the Medicare gap phase than any other major providers. This is important because once you and your plan spend $4,660 on drugs in 2023, you’ll pay up to 25% on brand-name drugs and generics until you spend $7,400 out of pocket on drugs and leave the donut hole. For example, some Aetna plans have $0 copays for generic drugs in the gap.

In a measure of plan value across the largest MA providers, Aetna was in the top 5%. “Plan value” weighs plan costs, such as monthly premiums, deductibles, and copays, against plan benefits, such as maximum out-of-pocket amounts, extra perks, and Medicare and NCQA star ratings.

Some Aetna plans feature $0 copays on primary care doctors and specialists, and all plans offer a concierge service to help you find services like home health care or pet and yard care. But if you live in Alaska, Hawaii, Minnesota, Montana, or Vermont, or want a PFFS plan (private-fee-for-service), you’ll need to consider another provider.

Blue Cross Blue Shield

Investopedia's Rating

4.5

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Pros & Cons

Pros

Highest average Medicare star rating of a national insurer
Most plans offer additional drug coverage in the gap
Highmark, a BCBS company, ranked highly for customer satisfaction
Excellent value for FL and TX plan members

Cons

Not available in all states
No Medicare Advantage PFFS plans

Why We Chose It

Blue Cross Blue Shield’s has an extensive provider network with an average Medicare star rating of 4.27 (for MA plans with drug coverage is), which is well above the industry average.

Overview

According to the Centers for Medicare and Medicaid Services (CMS), BCBS members have a better-than-average experience compared to members of other plans. In fact, BCBS MA plans with drug coverage are the highest-rated nationwide, except for Kaiser Permanente which only offers coverage in eight states.

BCBS also offers excellent value for members in Florida and Texas, based on a review of plans with the lowest out-of-pocket maximums in those states.

The company’s vast network includes names like Anthem Blue Cross Blue Shield and Highmark. Highmark has a more limited coverage area (Delaware, New York, Pennsylvania, and West Virginia), but was ranked third by J.D. Power for customer satisfaction.

Read more in our Blue Cross Blue Shield Medicare review.

Humana

Investopedia's Rating

4.3

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Pros & Cons

Pros

Second-widest plan availability
Ranked 2nd by J.D. Power for customer satisfaction
Benefits for over-the-counter drugs
Wide range of plan types available

Cons

Few plans offer additional drug coverage in the gap

Why We Chose It

Humana ranks highly for customer satisfaction (#2 by J.D. Power), is the second-largest Medicare Advantage provider, and is available in most states.

Overview

Humana is the second-largest provider of Medicare Advantage plans in 2023 nationwide, with 18% of the market in 2022. It also stands out as the second-best company for customer satisfaction, according to J.D. Power’s 2022 U.S. Medicare Advantage Study (behind Kaiser Permanente). HMO, PPO, and PFFS plans are available, depending on where you live, and Humana offers perks like an over-the-counter drug benefit.

The reason Humana doesn’t score higher is that few of its Medicare Advantage plans with drug coverage offer any additional coverage in the coverage gap. Fewer than one third, in fact. If you rely on prescription drugs and they cost more than $4,660 in 2023, you could be on the hook for 25% of their cost in the coverage gap.

Plans are available in all states except for Alaska, Rhode Island, and Wyoming.

Read more in our Humana Medicare review.

Kaiser Permanente

Investopedia's Rating

4.1

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Pros & Cons

Pros

Highest average NCQA rating nationwide
Five-star Medicare rating
#1 in J.D. Power’s U.S. Medicare Advantage Study
Lowest deductibles, on average, compared to all other major providers

Cons

Only available in 8 states and D.C.
Only offers HMO plans
No transportations benefits

Why We Chose It

Kaiser Permanents has the best customer satisfaction: All of Kaiser's 2023 Medicare Advantage plans have a five-star Medicare star rating and J.D. Power ranked Kaiser Permanente #1 for customer satisfaction in 2022.

Overview

Kaiser Permanente customers are very happy with their plans. All Medicare Advantage plans in 2023 receive five stars from Medicare, which is the highest rating available. And the average NCQA rating is 4.75 out of 5 stars, making Kaiser Permanente the highest-rated Medicare Advantage provider by the National Committee for Quality Assurance. The company also took top billing in the 2022 J.D. Power U.S. Medicare Advantage Study, beating the runner up (Humana) by 20 points.

Not only this, but compared to the other largest players, Kaiser Permanente drug deductibles are the lowest nationwide— only $5.60, on average, for 2023. One reason the company can keep member costs low may be that it only offers HMO plans for Medicare coverage, which means you’ll need to stay strictly in-network. And unlike every other provider on this list, Kaiser doesn’t cover transportation costs to health-related appointments.

You need to reside in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, or the District of Columbia to be eligible for coverage.

Read more in our Kaiser Permanente Medicare review.

Cigna

Investopedia's Rating

3.9

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Pros & Cons

Pros

Lowest overall-cost plans compared to the largest providers
Lowest average premium compared to the largest providers

Cons

Came in 8th for customer satisfaction
No PFFS plans
Limited drug coverage in the Medicare coverage gap

Why We Chose It

Cigna Medicare Advantage plans in 2023 are the cheapest, nationwide, of all major insurers offering Medicare Advantage plans.

Overview

Considering premiums, deductibles, and maximum out-of-pocket costs across all plans offered by the largest MA providers, Cigna has the lowest-cost Medicare Advantage plans with drug coverage in 2023. In particular, Cigna has the lowest average premium at $5.53 per month, and the second-lowest average drug deductible at $50.67 (Kaiser has the lowest).

Cigna offers HMO and PPO plans with drug coverage in 26 states. Its average Medicare star rating is 4.1, which is just above the national average of 3.97. However, it came in well below the industry average in the J.D. Power U.S. Medicare Advantage Study, ranking eighth out of the nine largest insurers.

Learn more in our Cigna Medicare review.

Final Verdict

To choose the best Medicare Advantage company, start by considering what you need out of a plan. Are you comfortable with an HMO or do you need additional flexibility? For instance, if you want a PFFS plan there are few providers to consider, including UnitedHealthcare, Aetna, Blue Cross Blue Shield, and Humana.

If you prefer low upfront costs, like a $0 premium, in exchange for a higher deductible, consider Cigna. But beware that customer satisfaction ratings are low. Or would you rather pay more monthly for a higher level of coverage? Check out UHC's AARP plans and Aetna.

Do you want a plan with drug coverage? If so, how much do you expect to spend on prescription drugs, and which specific drugs do you use? Medicare.gov’s plan finder lets you input the drugs you use when comparing plans to see which provide the best coverage. You can also see which specific plans provide additional coverage in the Medicare donut hole.

Keep in mind that individual plans have their own Medicare star ratings—we looked at national company averages. So even if you choose a top-ranked company like UnitedHealthcare, make sure the specific plan you’re interested in has a rating you’re comfortable with.

Frequently Asked Questions

What Is the Medicare Donut Hole or Coverage Gap?

The Medicare coverage gap or "donut hole" refers to a period when there is a limit on prescription drug coverage. It begins once the Medicare Advantage plan and member spend $4,430 ($4,660 in 2023) on covered drugs. During this time, members are responsible for up to 25% of the cost of brand name and generic drugs. Some plans offer additional coverage in the gap, such as $0 copays on preferred brand name drugs and generics. The gap ends once the member spends $7,050 ($7,400 in 2023) on covered drugs.
What Is the Highest-Rated Medicare Advantage Plan?

Kaiser Permanente’s 2023 Medicare Advantage plans with drug coverage all receive five stars from the Centers for Medicare and Medicaid Services (CMS). The CMS ranks Medicare Advantage and prescription drug plans on a five-star scale, from one to five stars, with five stars being the highest or best rating. A plan’s star rating reflects its performance, based on the experiences of the people enrolled in the plans.
What Is the Biggest Disadvantage of Medicare Advantage?

One of the main drawbacks to Medicare Advantage plans is that they typically have dedicated networks, such as an HMO or PPO. With Original Medicare you aren’t restricted to a network, and can choose any provider that accepts Medicare.
Can I Drop my Medicare Advantage Plan and Go Back to Original Medicare?

Yes, but you must do it during one of the open enrollment periods. You can switch back to Original Medicare during the annual Medicare Open Enrollment period from October 15 to December 7. Your new coverage will go into effect January 1. Or, you can switch during Medicare Advantage Open Enrollment from January 1 to March 31. Your new coverage will go into effect on the first day of the month after you ask to join the plan. If you return to Original Medicare, consider buying a Medicare supplement (Medigap) plan during open enrollment.

Methodology

Literature Review

We identified top companies by market share within the industry offering Medicare Advantage plans from various business and market insight databases including Statistia, Plunkett, and Gale. We also considered user-generated data from Google to determine public interest and trends in Medicare plans.

Data Collection and Verification

Our data was collected from third-party rating agencies, official government websites and databases, and directly from companies via websites, media contacts, and existing partnerships. Our sources include: AM Best, the National Committee for Quality Assurance (NCQA), J.D. Power, and the Centers for Medicare and Medicaid Services (CMS).

Data was verified to ensure data integrity and accuracy by cross-referencing the records and citation corresponding to each data point with our primary sources.

Ratings Methodology

We calculated star ratings for the quality of each company’s different plan types. Factors considered for companies offering Medicare Advantage plans were:

Plan quality and customer satisfaction (30%): CMS and NCQA ratings were considered to measure these criteria. Each organization independently rates the quality of Medicare plans on a one-to-five scale to help people compare plans during open enrollment.
Cost to value (20%): This is a measure of plan value based on plan premiums, deductibles, maximum out-of-pocket amounts, whether additional drug coverage is offered in the Medicare gap, and star ratings.
Additional coverage offered in the Medicare gap (15%): The coverage gap or "donut hole" refers to a period when there is a limit on drug coverage. During this time, members are responsible for up to 25% of brand name and generic drugs. You may spend less on prescription drugs if your plan provides additional coverage during the gap.
State availability (15%): This measure indicates how widely available plans are across the U.S.
Additional plan benefits (10%): This measure concerns additional benefits available, including vision, dental, hearing, non-emergency transportation, worldwide emergencies, gym memberships, and telehealth.
Types of plans available (5%): Insurance companies offer Medicare Advantage plans through managed care organizations, including HMOs and PPOs. This measure concerns the number of managed care options available.
Special needs plans (5%): This is a measure of whether the company offers plans designed for those with specific diseases.

Research and analysis by Shanker Narayan

Article Sources

Investopedia requires writers to use primary sources to support their work. These include white papers, government data, original reporting, and interviews with industry experts. We also reference original research from other reputable publishers where appropriate. You can learn more about the standards we follow in producing accurate, unbiased content in our editorial policy.

CMS.gov. “Medicare.”
NCQA. “Health Plan Accreditation.”
J.D. Power. “2022 U.S. Medicare Advantage Study.”
CMS.gov. “Prescription Drug Coverage - General Information.”
KFF. “Medicare Advantage in 2022: Enrollment Update and Key Trends.”