If you receive medical coverage through Medicare and wonder what the dreaded “donut hole” is, or have found yourself in the middle of it, 2013 could bring more relief for people requiring prescription medications who qualify for Medicare: You are over 65, you are under 65 with certain disabilities, or have permanent kidney failure.
Medicare Part D is coverage that allows you to opt to pay a monthly premium to help cover the cost of prescriptions. The problem is, there is a huge gap in the coverage, leaving the cost of the gap up to the beneficiary. You must be eligible and enrolled in Medicare to receive Part D, and must do so when you first sign-up to avoid penalties.
In 2013, participants will need to meet a maximum annual deductible of $325 and will have coverage until the donut hole begins at $2,970. The gap continues until the participant spends $4,750. Then Part D coverage steps in again with minimal cost to individuals. Co pays depend on the coverage you have.
In 2012, participants received a 50 percent discount on name-brand drugs in the donut hole, and saw lowering costs on generic drugs. Getting more for your money helps close the gap. This discount goes to 52.5 percent in 2013. The entire price of name-brand drugs counts towards out-of-pocket spending by participants.
Discounts for generic drugs while in the donut hole will go from 14 percent to 21 percent in 2013. The gap should be closed by 2020, when participants will pay 25 percent of the cost of drugs until reaching the annual out-of-pocket spending limit.
Insurance coverage to cover the gap can be obtained by joining a Prescription Drug Plan (PDP) that covers prescriptions only, or by joining a Medicare Advantage plan (MA) that will cover prescriptions and medical services as part of Medicare Part C.
Next time - more information on PDPs and MAs (not to mention PFFS, MSA, HMO, PPO) - what they mean, what’s available and what it could cost you, limits to what is covered, and important time frames that will help with enrollment penalties.
Please take a moment and comment on this article below. Click on the subscribe button to receive an e-mail when Alison publishes new articles. Alison is also Book Examiner, Community Issues Examiner, Salt Lake City Comfort Food Examiner and Salt Lake City Political Buzz Examiner. For a link to all of Alison’s Social Issues articles, please click here. Thank you.
Source: Medicare.gov, Allsup, Medx Publishing