Avoid the Medicare donut hole

November 1, 9:09 AMFinancial Literacy ExaminerClaire Moore

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Avoid the Medicare donut hole

donut

If you have Medicare Part D coverage for your prescriptions you may have been surprised to find  that there is a gap in your coverage. This gap, also known as the “donut hole” occurs during a year in which you have paid for the deductible and co-pays reaching a maximum set by your plan. The gap typically applies to those who either take several medications or a few very expensive medications. It is possible to avoid the gap by taking low-cost generic medications instead.

A typical scenario involves a patient who pays a $295 deductible then pays 25% of the cost of medications until reaching a total out-of-pocket expenditure of $2,700. Subsequent prescriptions must be paid for 100% until the total out-of-pocket paid rises from the initial $2,700 to a grand total of $6,100. At this point catastrophic coverage takes over and most of the cost of prescriptions is paid by Medicare.

Rather than wait until the gap hits your pocket book, you should work with your doctor to make sure that you are taking advantage of lower cost generic medications whenever possible. Check with the pharmacies in your area to find out which of your medications is included in their $4.00 prescription programs. If all of your medications can be purchased through these low-cost providers such as Target and Wal-Mart, then you might not need Part D coverage at all. To find out more, go to Medicare.gov and use their Medicare plan comparison tool.

If you need help paying for your medications you can go to the National Council on Aging site for resources. You will also find information on help paying for food and utilities. If you are enrolled in Part D and need assistance in paying for your medications then you should look into the Pharmaceutical Assistance Program offered by many of the major drug manufacturers. Additional help may be available from your state.

To find out if you’re in danger of falling into the donut hole, go to the AARP Doughnut-Hole Calculator.


For more information:

Bridging the Coverage Gap

Remarks by the President on the Medicare part d "doughnut hole" and AARP endorsement

Medicare Part D Enrollment Approaches

Single Payer healthcare aka Medicare