Toni:
A few months ago, you wrote about how to stay out of or not get into the “Donut Hole” so quick. I have cancer and the cost of drugs associated with my cancer is eating my lunch. Can you please give me some tips on what to do or where I can go to get some help? Thanks, Vicki from Alvin
Hello Vicki:
This week I heard from a client who has MS and her copaxone cost over $4,000 for her injections. I referred her to a Prescription Drug Assistance program in Lake Jackson that helps people who are having a hard time paying for their drugs. And guess what Vicki, you do not have to be on Medicare for their assistance. Shirley Gillman and her organization Prescription Assistance Program will help anyone. They can be reached at 979/285-1430. She has saved people almost $64,000,000(million dollars) by going direct to the manufacturer. They help people get their prescriptions are no cost. If her group can’t help you…I don’t know who can.
Let me explain again what the donut hole is for those who are just beginning this Medicare Part D journey. Every year your Prescription drug Part D plan starts all over and January 1, 2012, when the total true cost of all prescriptions both brand name and generics (true cost is all co pays for the Part D prescriptions that you pay and the remaining RX cost the Part D Insurance Company pays) reaches $2,930 for your covered drugs, then you are in the famous “Donut Hole” or coverage gap.
Beginning in March 2010, when President Obama signed the Healthcare Reform, you no longer had to pay the full cost of your prescription drugs when you entered the donut hole. Those who have a Part D plan receive a 50% discount on “covered” brand name prescription drugs which counts as out of pocket spending and until one gets out of the “Donut Hole”. You will pay 50% of the “covered” brand name drug and the drug manufacturer also pays 50% of the “covered” drug. There is also a discount of 14% for “covered” generic drugs. If a prescription is not “covered” on a person’s Part D plan, then they will pay 100% for that prescription and not have the 50% discount.
Everyone who gets in the “Donut Hole” must spend $4,700 out of pocket for 2012 to get out of the “Donut Hole” or coverage gap. When a Medicare beneficiary gets out of the “Donut Hole”, she enters Catastrophic coverage and pays a small co pay for each prescription drug until the end of the year and on January 1 of each year, the process starts all over again.
*** What confuses many is that the total cost of the prescription is reported to Medicare from the Part D insurance company…not the total amount of co pays that you have paid!!
TIPS to help stay out of the Donut Hole or not get in it as soon!
1. Do Prescription Drug Planning. Use AARP’s Doughnut Hole Calculator which is located at http://doughnuthole.aarp.org.
2. Talk to your Doctor about what brand name drugs can be changed to generics.
3. See what generics are part of $4 or $5 generic prescription drug programs at HEB, Wal-Mart, and Kroger etc… Pay for affordable generics out of your pocket
4. Get samples of your prescriptions from your doctor. This can keep you from going into the “Donut Hole” as soon.
5. Call Shirley Gillman’s organization at 979/285-1430. She is a true Angel for what she does and she doesn’t cost a penny!
Toni King is an advocate/consultant for those “Confused about Medicare”. Medicare open enrollment begins Oct 15th and if you would like a “Confused about Medicare” workshop for your church, group or company send Toni an email at toni@tonysays.com or call 281/830-3896. Visit Toni’s new website and blog at www.tonisays.com.
