Toni:
This year, my mother got into the “donut hole” in September. It has financially devastated her and she almost stopped taking her prescriptions. She can afford her co pays of $80.00 per month, but it shows on her statement that the true prescription drugs cost is $650.00 per month. How can I help her stay out of the “Donut Hole or not get in it so fast? Thanks in Advance…Susan from West U.
Hello Susan:
Your mother’s prescription drug problem is typical of the average person on Medicare. She can afford her $80.00 co pays, BUT… has no idea that the actual cost of her prescription drugs is $650.00 each month. Your mother pays the co pays for the Part D plan and the Plan pays the remaining RX cost until the total prescription drug cost reaches $2,930 in 2012 for her covered drugs, and then she is in the famous “Donut Hole” or coverage gap.
Most people on Medicare that get in the “Donut Hole” worry how they will afford their prescriptions and also pay their lights, car payment, rent not to mention buy some Christmas or birthday presents for their precious grandchildren.
*** What confuses the average person is that the total cost of the prescription is reported to the insurance company and they report the total amount to Medicare. Most think it is the
co pay that is being reported to Medicare. I have a very hard time trying to help people understand that you do not have to put every prescription on your Medicare prescription drug card. Use your card for your high priced drugs because once you get in the “Donut Hole”, you have to spend $4,700 to get out of it.
This week…I learned a Medicare Part D lesson…Want to know what it is!
I was counseling a new 67 years old client about Medicare and Part D, only to find out that he was in the “donut hole”. And out of 8 meds 5 were the plans $0 co pay generics with 3 being brand name drugs costing $567.32. What a real savings!! He thought $0 was being reported to Medicare when in reality $347.92 was reported for the $0 co pay generic drugs.
My client was astonished to learn that his 5 generics could have been filled with HEB’s $5 discount prescription drug program costing him $25 and keeping him from putting $347.92 on his Medicare Part D plan.
He would have gone into the “donut hole” in Sept, 2012 instead of this past April 15 as he did this year. Using HEB, Don would have paid $25 direct to HEB and not place the 5 generics on his Part D plan and use his plan only for his expensive brand name drugs or generics that are not in the HEB, Kroger or even Wal-Mart’s discount prescription drug program.
The “donut hole” is not a whole lot of fun to get into and there are a few tips that can help you stay out of it or not get into the “donut hole” as fast.
1) Visit AARP’s Donut Hole Calculator located at http://doughnuthole.aarp.org. Once you put your drugs in the system, it will tell you when you will get in the “donut hole” and what less expensive drugs are available or inexpensive generics.
2) Talk to your doctor about changing brand name to generics.
3) Get samples of prescriptions from your doctor.
For those “Confused about Medicare” join me for my annual Medicare workshop on Tuesday, October 23, 2012 at 6:00 PM at the Sugar Creek Baptist Church-Chapel, 13213 Southwest Frwy, Sugar Land, TX 77478. RSVP: 832/800-4674…Everyone welcome.
Toni King is advocate/consultant for those “Confused about Medicare” send Toni an email at toni@tonisays.com or call 832/519-TONI (8664). Visit www.tonisays.com and “like” Toni Says on facebook. Open Enrollment begins Oct 15th, please give Toni a few days to answer emails; she will get you an answer.
