OBJECTIVES: More than a third of chronic obstructive pulmonary disease (COPD) patients enter Medicare coverage gap or donut hole every year increasing the cost sharing burden. This analysis assessed the association of falling into the coverage gap on number of hospitalization, ER visit/s and time to hospitalization among COPD patients.   METHODS: A retrospective cross-sectional cohort study was conducted using Cigna-HealthSpring Medicare Advantage database, which captures members in south eastern Texas.  Subjects were included if they had  ≥ ICD-9 code (491.XX, 492.XX, 496.XX) for COPD, from their medical claims between January 1, 2011 and December 31, 2013.   Three cohorts were compared: 1) patients not in coverage gap 2) patients in the gap and 3) those in gap with catastrophic coverage.  Cohorts were matched 1:1 based on their propensity score calculated on age, plan type, index year, and Charlson Co-morbidity Index (CCI). Chi-square was used to compare resource utilization, and Cox proportional hazards model was used to compare time to hospitalization across the matched cohorts. RESULTS: A total of 3,142 COPD patients were identified with 79% in no gap, 10% in gap and 11% in gap with catastrophic coverage. Matched COPD patients who fall in gap (54%) compared to those not in gap (48%) differed significantly (p<.01) in total hospitalization and ER visits. Patients within gap (HR: 1.35, p <.001) and gap with catastrophic coverage (HR: 1.44, p<.001) have a likelihood of being hospitalized compared to patients in no gap while controlling for CCI, age and sex.  CONCLUSIONS: COPD patients who fall into the coverage gap have higher resource utilization than those that do not reach the gap. Patients in coverage gap and those in gap with catastrophic coverage were more likely to be hospitalized than those in no gap. Those that reach the coverage gap may be at greater risk of hospitalization.