Toni:
“I remember hearing on the news that the “Donut Hole” is going away because of Obamacare. Is this true? I need serious prescription drug help for my 72-year-old mother.
She got into the “donut hole” in May of this year. It has financially devastated her and ruined her health because she stopped taking her expensive blood pressure meds and had a stroke.
She could afford her co pays for her 5 meds that totaled $80.00 per month, but the true prescription cost of her drugs were really $650.00 per month.
I now have everything taken care of with $0 generics and 2 brand name drugs with a new Part D plan that starts January 1st, 2014.
Can you please advise me how can I help her stay out of the “Donut Hole or not get in it so fast?”
~ Thanks in Advance…Susa, a new reader from Dallas, TX.
Hello Susan:
Obamacare Rumor: Is the Donut Hole going away!!
Not in 2014 or 2015, but it is to go down to a 25% Medicare beneficiary out of pocket, but not until January 1, 2020. I would say this is a play on words because the “Donut Hole” will never totally go away!
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 was $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 $2850 in 2014 for her covered drugs, and then she is in the famous “Donut Hole” or coverage gap. In 2013, the Donut Hole began at $2,970. I’d say it did not change a lot. Wouldn’t you?
*** What confuses the average person is that the total cost of the prescription is reported to the insurance company and insurance company reports the total amount to Medicare. Medicare knows exactly how much is being spent on your mother’s Part D card and the minute she reaches the “Donut Hole”, her pharmacist informs her.
Most think it is the co pay that is being reported to Medicare not the actual cost of the prescription.
I have a very hard time having 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” for 2014. You have to spend 47.50% for brand name drugs and the prescription drug manufacturer will spend the other 52.50% for their prescription drug brand until the total amount of $4,550 is spent to get out of it.
Be sure all of your prescription drugs are covered on the Part D plan or you will spend 100% of the cost of that prescription.
When counseling a new client about Medicare and Part D, I advise them that if the plan has $0 co pay generics, then check out the generic prices of $5 at HEB or $4 at Wal-Mart and Kroger. Their generic clubs only need a prescription not a prescription drug card for you to receive the discounted price.
Toni’s tips to stay out of the “Donut Hole” or not get in it as fast:
- Visit AARP’s Donut Hole Calculator located at http://doughnuthole.aarp.org. It will tell you when you will get in the “donut hole” and what less expensive drugs are available or inexpensive generics.
- Talk to your doctor about changing brand name to generics.
- Get samples of prescriptions from your doctor.
- Check and see if you qualify for prescription drug financial assistance.
Toni King, advocate/author of the Medicare Survival Guide, her simple guide that puts
Medicare in “people” terms is on sale at www.tonisays.com. Contact Toni directly at 832/519-TONI (8664) for help.
