Toni:
Last year, my mother got into the “donut hole” in October. I can see from the Part D statement she receives she is rapidly approaching the limit. She can afford her co pays of $104.00 per month, but not the true prescription drugs cost is $630.00 per month. I need to know how to help her stay out of the “Donut Hole or not get in it so fast? She does not qualify for “Extra Help” because she makes about $50 too much in her Social Security check. Please give me some ideas! Thanks Joyce from Spring, TX
Hello Joyce:
Your mother’s prescription drug problem is typical of the average person on Medicare. She can afford her $104 co pays, BUT… has no idea that the true cost of her prescription drugs is $630 each month. Once her Medicare Part D prescription drug plan and the co pays she pays totals $2,970 for her covered drugs, then she is in the famous “Donut Hole” or coverage gap.
In 2013,those who have a Medicare Part D plan receive a 52.50% discount on “covered” brand name prescription drugs that counts as out of pocket spending and help her get out of the “Donut Hole”. She pays 47.50% of the brand name prescription and the prescription drug manufacturer will pay 52.50% of the “covered” drug. Everyone who gets in the “Donut Hole” must spend $4,750 out of pocket for the year to get out of the “Donut Hole” or coverage gap. When she is 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. January 1 of each year, the process starts all over again!
*** 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 which includes your co pay to Medicare. Most think it is the co pay that is being reported. 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 cost drugs because once you get in the “Donut Hole”, you have to spend $4,750 to get out of it.
Toni’s Tips to help you stay out of the Donut Hole or not get in it as soon!
1. Only put your brand name prescription drugs on your Part D Medicare Prescription Drug plan or generics that are not affordable. Most generics are very affordable and you can pay for those out of your pocket.
2. See what generics are in a $4 or $5 generic prescription drug programs at HEB, Wal-Mart, and Kroger etc… Pay for the generics out of your pocket. You do not need a Prescription Drug plan to get their discounted price you only need a prescription from your doctor.
3. Talk to your Doctor about what brand name drugs can be changed to generics.
4. Get samples from your doctor. This can keep you from going into the “Donut Hole” as soon.
These tips and more are available in Chapter 7 of my Medicare Survival Guide, or email me at toni@tonisays.com and I can help with Medicare Part D prescription drug planning. Understanding Medicare’s Part D can help prevent someone from not being able to afford their prescriptions when they are desperately needed.
**** Join Toni on Wednesday, May 15th, 2013 at 6:30PM for a Confused about Medicare Workshop to be held at The Abbey at Westminster Plaza, 2865 Westminster Plaza Dr., Houston, TX 77082. The presentation is free of charge and open to the public. ****
RSVP by calling 832/800-4674 as seating is limited. Medicare Parts A, B, C and D will be explained completely.
Toni King is the author of Medicare Survival Guide is available only at www.tonisays.com and not sold in bookstores. Toni is an advocate/consultant for those “Confused about Medicare”. Email questions to toni@tonisays.com/ask-toni or call 832/519-TONI (8664).
