When the Medicare Modernization Act of 2003 (MMA) established the Medicare Part D prescription drug benefit, it defined a standard benefit that includes a gap in coverage as a way of limiting federal spending. When beneficiaries fall into this so-called doughnut hole, they are responsible for the full cost of their prescription drugs plus they must continue paying their Part D premiums even though they are not receiving benefits. Under the standard benefit in the MMA, Medicare Part D beneficiaries are responsible for a $250 yearly deductible and then 25 percent – or $500 – of the next $2,000 in covered drug costs, while their private plans pay 75 percent – or $1500 – of the $2,000. Once a total of $2,250 has been spent on drugs, beneficiaries fall into the doughnut hole; prescription drug coverage stops but monthly Part D premiums must still be paid. Many beneficiaries are shocked at how quickly they reach the coverage gap because they don’t realize the $2,250 spending limit includes both the money they spend out of their own pockets as well as the portion of drug costs paid by their private plan. Beneficiaries in the doughnut hole are responsible for paying the next $2,850 of drug costs out-of-pocket – bringing total spending to $5,100 – before they are entitled to catastrophic coverage.