Showing posts with label donut hole. Show all posts
Showing posts with label donut hole. Show all posts

Thursday, September 10, 2015

The Donut Hole is Real

If you're covered under Medicare Part D, the “donut hole” is real, and can dramatically affect the cost of your prescriptions. Here’s how and why.

What is the Medicare donut hole?

The "donut hole" is a coverage gap in certain Medicare prescription drug plans. This gap is a temporary limit on what the plan will cover.

As part of the Affordable Care Act, the health insurance program Medicare gives qualified recipients (people 65 or older, people under 65 with certain disabilities, and a few others) the option of paying a monthly premium for outpatient prescription drug coverage. This section is called Medicare Part D.

With Medicare Part D, you pay a monthly premium, plus the full price of your medication until you reach the $310 deductible amount. After meeting this deductible, you pay 25 percent of your prescription drug costs, until the total spending between you and your plan reaches a certain limit ($2,960 in 2015, or $3,310 in 2016).

After you hit this limit, the coverage gap, or “donut hole,” begins. You are now responsible for 45 percent of the cost of covered brand-name prescription drugs until you reach the yearly out-of-pocket spending limit (which differs from year to year), after which coverage kicks back in.

Reducing the wallet impact of the donut hole

If you're looking to save during the coverage gap, switching over to generics could be a good option. Medicare pays 35 percent of the price for generic drugs during the coverage gap, as opposed to 45 percent for brand-name. More good news: the percentage you pay for generics during the coverage gap will decrease each year until it reaches 25 percent in 2020.

However, even with these discounts on generics, the Medicare “donut hole” can make it hard for senior citizens without any supplemental plan to pay for their prescriptions. This is a good reason to look into the FamilyWize Prescription Savings Card. It’s free to obtain and use, and gives you discounts on prescriptions, whether you're insured or uninsured. There’s no registration required, and using the card when buying prescription drugs can save you up to 75 percent.

Just show the FamilyWize card to your pharmacist the next time you pick up a prescription, and ask them to compare the discount offered by the card to the discount offered by your insurance. In many cases, the FamilyWize price is often the better deal. You can also check the price and compare before picking up by using our Drug Price Lookup tool, available on our website or through the smartphone app (just search "FamilyWize" on your smartphone's app store).

You can also check to see if you qualify for Medicare’s Extra Help options for paying Part D, which prevents you from entering the coverage gap. Also, check out the Medicare website’s Part D section for further information on the donut hole gap, with scenarios to help explain it.

Ric Moxley
Contributing Writer

Friday, June 29, 2012

Options for MediCare Part D Prescriptions

Working at FamilyWize really gives me assurance that there are always options when it comes to getting needed prescription medicine - even those of you in the donut hole who are probably asking, "Now what?" 


medicare prescription assistance programs
Light on the other side of the Donut Hole.
If you are new to Medicare and the Part D prescription coverage gap, then there are a few things you need to know:
  1. There is a temporary gap in prescription coverage depending on the plan you've chosen so your monthly prescription medication costs may rise.
  2. Whether or not you enter into the coverage gap is based on your drug plan spending for those drugs that are covered.
  3. 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.  
Confusing? For more information or help go to www.medicare.gov or call 1-800-MEDICARE or check with your pharmacist.


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 do enter the coverage gap, as promised from last week's blog "The Dreaded Medicare Donut Hole"; here are some options and resources on how to land softly and survive the donut hole dunk! 

If you think you will spend enough to get out of the gap - DO NOT use these options.
  1. 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.
  2. 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.
  3. 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! 
  4. 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.
  5. 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.
  6. 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.
Whether you are in the donut hole or are able to spend enough to get catastrophic coverage,  we want to help you find options!  If you know of options that are not listed here, please share!

Krysta W.

Thursday, June 28, 2012

Affordable Health Care - The Court's Decision

It has been decided.  The Supreme Court made their ruling regarding the Affordable Care Act.  The court upheld the mandate that the federal health care reform bill, brought forth by President Obama and Congress, can require Americans to buy health insurance or pay a penalty stating that it is "characterized as a tax," which is permitted by the Constitution.
medicine uninsured health care cost
Supreme Court passes federal health care reform bill.

FamilyWize does not take a political position on this decision.  Our stand is that we fully support affordable health care for all children, individuals, and families in the United States.

But even as government moves forward to implement the federal health care law, there is nothing in legislation that mandates coverage of prescription medications.  

There is an unprecedented and growing need for prescription medicine coverage.  More than 80 million people in the U.S. are uninsured or underinsured.  More than ever, people need access to affordable medical and prescription coverage.  


Even when this Affordable Care Act is implemented in 2014 problems with the rising cost of medical bills and prescription medication do not go away.  In order to make health care more affordable, insurance plans are cutting out or cutting back healthcare coverage, and especially prescription coverage.  No matter who you are in America; the increasing costs of getting necessary prescription medicines may seem to be an UN-Affordable act.

There Are Options and Help with Your Health Care Bills

Since 2005, FamilyWize has been working with the United Ways to provide affordable prescription medicines to everyone in America whether they have health insurance or not.  FamilyWize has set a goal to "reduce the cost of medicine for children, families, and individuals by $1 billion by the end of 2015."

affordable health care
Family Wize discount drug card is free nationwide.
With the constant changes in Medicare, Medicaid, and increased expenses to state and federal governments, every person can help another person get a FREE FamilyWize United Ways prescription discount drug card. We are a country "united" and we need to work together to make affordable options in prescription drug costs.  Across our country over 60,000 pharmacies are providing discounts to individuals and families who may not otherwise afford their prescribed medicines.  From the Medicare Donut Hole to middle and lower income individuals and families who are uninsured or under insured - health care costs are on the rise for everyone.

So please take one minute today to help do your part in making health care more affordable.

Print a discount drug card or text the word "family" to 700700 and  start saving money on prescription medications!

Friday, June 22, 2012

'Much A Do'-Nut About Nothing

Ahhh - TGIF! As I pondered the topic of today's blog - I switched gears.  I decided it would not be serious, because sometimes life just needs to be NOT serious!  Plus, we gave you much to think about yesterday with "The Dreaded Medicare Donut Hole."  The Medicare Donut Hole is one donut hole that cannot always be avoided, but over the next couple of weeks, but we hope to point you toward some resources that might help with Medicare Part D.

Now - on to more pleasant topics - the actual donut.
Medicare part D health articles
The donut dilemma: Medicare donut hole or actual donut hole can cost you.

Although I am typically not a partaker of donuts, the fact that I will be traveling across the wonderful state of Pennsylvania this weekend got me thinking to my destination and what awaits on the other end.  There is a small place - what some would consider "a hole in the wall" back in a small town in Western Pennsylvania that offers up the most delicious doughnut that I have ever tasted.  The homemade kind that is soft and light and airy.  My favorite is the cinnamon coffee roll that is bigger than my hand with a maple glazed icing that is to die for.  These creations of Clark's Donuts are definitely 'Much a Donut about Something.'

 But, I digress.  Typically a health conscious woman except for the occasional Clark's donut, I decided to see what the Web and research had to say about donut nutrition facts and health.  Of course there were health articles and blogs and more of those touting the goodness of donuts, while others like Carla Wolper, a nutritionist at the New York Obesity Research Center who had this to say about the donut, "When it comes to health, the only thing good about them is the hole."

Donut nutrition facts
Krispy Kreme glazed donut = 237 calories.
I also discovered that the USDA 2005 dietary recommendations gave a thumbs up on "discretionary calories".  So what does that mean for you?  If you eat a 2,000 calorie a day diet, then you can have 237 discretionary calories, which is almost the calories in a Krispy Kreme glazed donut (according to the CalorieLab website).  Although portion control is recommended on any diet by doctors and dietitians, I would venture to guess that an occasional donut will not harm you.  A donut a day however is not what the doctor ordered. 

Which led me to a search on donuts and medicine.  This merely resulted in a listing of donut stores in several towns called Medicine (Medicine Park, OK and Medicine Lodge, KS).

Try, try again.  What I did discover was research from the Journal of Humanpsycopharmacology suggesting that "the synergistic effects of caffeine and glucose can benefit sustained attention and verbal memory." (Copyright 2010 John Wiley & Sons, Ltd.) A good thing right?  Good food equals good thoughts?  Not sure that this is what it meant, but if you want to read more go to the Wiley Online Library where the study is printed.

Of course, you can counter that with a study published by the Public Health Nutrition Journal and the US National Library of Medicine, regarding a study by the University of Las Palmas in Gran Canaria and the University of Navarra, that assessed the relationship between fast foods and processed pastries to a 37% risk increase for depression.  

So before you have your Saturday morning run to the local bakery for donuts and coffee, consider this blog.

Today was just some "food for thought."  (I couldn't resist.)  But you must make your own determination of whether or not when it comes to the illustrious donut, if there is 'Much a Do'nut about Nothing.

Donna Cornelius
Online Marketing Manager

Thursday, June 21, 2012

The Dreaded Medicare Donut Hole

Donut hole:  I love donuts! Mmmm what a sweet circular treat and breakfast staple.  Chocolate, glazed, cinnamon, powdered sugar--there is a plethora of flavors. 

But...from a personal experience here in the call center, I can tell you there is ONE donut hole flavor that doesn't taste or look appetizing at all for people on Medicare Part D.  This time of year, we get so many calls from people falling into the ominous Medicare Donut Hole. 

Can you imagine what it is like to be on a fixed income?  Watching gas prices go up and down, worrying about unexpected expenses, and waking up one day to find that instead of paying 25% for your medicine, it's now 100% out of YOUR pocket!?

For those who aren't familiar, Medicare is a federal health insurance program for Americans 65 and older, people with end stage renal disease, and younger people with disabilities. 


medicare part D
Nothing sweet about the Medicare donut hole.
There is an optional component to Medicare, called "Part D," which is a co-pay prescription coverage plan offered at an additional cost to help people pay for their prescription medications.   However, every year, Medicare Part D recipients fall into a coverage gap (aka donut hole). 

What happens in the donut hole?  Nothing sweet.  

All of a sudden, individuals with Part D go from paying a 25% copay for their much needed medications to paying full retail price. 

Here are a few tips to prepare yourself: 

1. Read the fine print.  I once read somewhere, the only constant thing about Medicare is change.  I couldn't have said it better myself! Make sure you read your coordination of benefits agreement. Read the fine print to make sure everything is in order and if you have questions, ASK!  Also make sure all your medications are covered. Just because your medications were covered last year, doesn't necessarily mean they are covered again this year. 

2. Plan ahead.  If you know you are going to hit the donut hole, ask your pharmacist early in the year what the monthly payment for your current medications will be once you are in the donut hole, including the rebates for brand names and generics.  See if that will be enough to get you out of the donut hole and qualify you for catastrophic coverage.  

If you aren't sure you will hit the donut hole, ask your pharmacist to help you calculate your prescription costs to see if you will or will not. 

3. Be aware of your calendar. Open enrollment for Medicare usually begins every October. Leave yourself enough time to review each plan to see which one is better tailored for you.  

4. Don't be shy. Always consult your pharmacist or plan provider should questions arise. For specific questions, you can call 1-800-MEDICARE or visit the official U.S.  government site for Medicare at www.medicare.gov

Visit our blog next week to look for what options and resources you have once you or loved ones have fallen into the dreaded Medicare donut hole.

Krysta W.