HOW TO AVOID THE MEDICARE PART D "Donut Hole"
/Did you know about the Medicare Part D "donut hole" and how to avoid it?
The Part D coverage gap or "donut hole" occurs when a person reaches a specific spending limit for their medications and must pay more of the costs after reaching that threshold.
The following are ways you can avoid the donut hole altogether or get financial assistance if you fall into the coverage gap.
Shop around
The Annual Enrollment Period for Medicare Advantage Initial Coverage Election Period runs October 15 – December 7. During this time, people who are eligible for Medicare can join, switch, or leave plans.
This Part D plan checklist, developed for National Council on Aging, provides a list of questions to ask before selecting prescription drug coverage. Aside from reviewing costs, you should choose a plan that covers all/most of your medications and makes it convenient for you to fill your prescriptions.
The Medicare Plan Finder is a tool you can use to compare plans and determine your costs in the coming year, including when/if you may fall into the "donut hole". Some Medicare plans may offer additional coverage during the coverage gap, for instance, generic drugs; however, they may also charge a higher monthly premium.
What's ahead
You may have heard that the Affordable Care Act was set in motion to close the Part D coverage gap in 2020. However, "closing" does not mean that people reaching the donut hole do not pay anything for their drugs. Instead, it indicates that plans and pharmaceutical companies pick up more of the tab.
For example, beginning in 2019, Medicare beneficiaries enrolled in Part D prescription drug plans reaching the donut hole will still pay 37% of their generic medications' costs and 25% of the brand-name medications.
Resources to help
If you are unable to avoid the "donut hole", you should explore these options to help pay for your prescriptions:
Louisiana RX Assistance Plans: Several prescription assistance programs help curb the costs of medicines if you meet specific eligibility criteria.
Patient Assistance Programs: Many brand-name drug manufacturers have these programs to provide discounts or no-cost medications to those who qualify. You must provide proof of income and the cost of the prescription to take advantage of these programs.
Generics: Talk to your doctor about whether generics are a good substitute for your brand-name drugs. If your medication is in a higher cost tier or is not covered on your plan's formulary (approved drug list), you can ask for an exception to get the plan to cover it entirely or at a lower cost.
"Best" Price: You can also ask your pharmacist for the "best" price for the prescription. Sometimes costs for drugs are ss if you do not use your insurance. Be mindful that any medication you purchase outside of your insurance will not count toward satisfying your deductible, nor will it apply to the "donut hole".
Avoiding the coverage gap entirely
Check whether you qualify to receive Medicare's Extra Help/Part D Low-Income Subsidy if you have limited income and resources. Extra Help has helped people save significantly on their prescription drugs.
