|Light on the other side of the Donut Hole.|
- There is a temporary gap in prescription coverage depending on the plan you've chosen so your monthly prescription medication costs may rise.
- Whether or not you enter into the coverage gap is based on your drug plan spending for those drugs that are covered.
- Once you enter whether or not you will exit the donut hole additional funds and qualify for catastrophic coverage for the remainder of the year is based on your out of pocket expenses while in the Medicare coverage gap.
If You Calculate That You Won't Spend Enough Money Out of Pocket to Qualify for Catastrophic Coverage... Then Here Are Tips to Make the Best of the Coverage Gap While You Are In It
If you think you will spend enough to get out of the gap - DO NOT use these options.
- Compare, Compare, Compare - If you are not going to spend enough to get out of the donut hole, say it with me-COMPARE! There are many options from manufacturer rebates to store programs that may be able to help you save a chunk of money.
- Chat with your Pharmacist - Your pharmacist is aware of different programs that can be used in conjunction with Medicare Part D insurance. Talk to your pharmacist to see which program would work best for you based on the medications you are prescribed.
- Talk to your Doc - Your doctor doesn't necessarily know what health insurance you have because there are medical billers whose jobs are to handle insurance matters. (I know this because a good friend is one!) Let your doctor know that you are a Medicare Part D recipient and have fallen into the donut hole. See if your brand-name prescription medications have generics that could be just as effective. Your doctor might have some other tricks like changing your medication's strength or dosage to save you money or even hook you up with some samples to get you through to the other end of the gap. Who doesn't love samples!
- Resources - National Council on Aging (NCOA) is a non-profit and advocacy organization that works with various organizations to help seniors find jobs and benefits, improve their health, live independently, and remain active in their community. It offers a free service called BenefitsCheckUp. After you answer a series of questions, it creates a personalized report of the programs that may be able to assist you in areas such as medication, food, and housing. You can also view different State Pharmaceutical Assistance Programs put together by Medicare.gov that may be able to give you a hand.
- Talk it Out - Check out message boards or blogs to connect with people who are in the same boat you are. It might make the process a little bit easier. Online support can be a great resource.
- FamilyWize - We can help Medicare recipients who have fallen into the donut hole. If you know you won't get out, you can use FamilyWize FREE discount prescription drug card to save up to 75% on your generic medications. FamilyWize can be used for FDA-approved medications in and out of the gap that aren't covered by Medicare when purchased at a participating pharmacy.