Now’s the time to start thinking about the Donut Hole
At the end of the year, during the open enrollment period, you should be thinking about how you’ll managing prescription costs. Why worry about prescription drug costs if you have a Medicare Part D plan? Just because you’ve never reached the coverage gap, or the dreaded donut hole, it doesn’t mean that you won’t. As Americans age, the number of drugs taken on a regular basis grows. It’s also not uncommon for the added prescriptions to be of the more expensive variety rather than the generics.
If you’re not quire sure how they calculate the prescription expenses, you’re not alone. A recent national survey of Medicare Part D enrollees conducted by Medco Health Solutions, a large manager of pharmacy benefits, showed a significant lack of understanding of how the prescription expenses are calculated.
The Medco survey found:
- that 61 percent of enrollees don’t fully understand the Medicare Part D Coverage Gap
- 3 out of 4 Medicare enrollees do not understand how much of their prescription costs count toward the Coverage Gap
- 1 in 3 enrollees in the Coverage Gap said it was difficult to keep track of his or her prescription drug expenses as he or she approached the Coverage Gap
- 43 percent of enrollees who are in the Coverage Gap claimed they reached it before June.
The most important thing to remember is that both the subscriber and the provider expenses are used toward the calculation, meaning that for a $100 prescription where you pay a $10 copay, the full $100 gets counted as you approach the gap. For 2009, you reach the gap when prescription expenses reach $2,700. After that, you have to incur $4,350 of drug expenses before Part D kicks in again. Needless to say, you want to be as frugal as possible with the first $2,700.
A recent article in the Wall Street Journal gives the following tips for avoiding the donut hole:
- Go retail: check with chains like Wal-Mart, Target and others for their generic programs. Often you can get them for the cost of your copay give or take. If you don’t use the plan for these drugs it doesn’t count against you.
- Fill the gap: some stand-alone Part D plans offer some sort of gap coverage. Be sure to check with your Medicare Advantage, or HMO, to be sure that a stand-alone plan isn’t prohibited by Medicare. Some Medicare Advantage plans also offer some gap coverage. It won’t pay for it all, but it can help.
- Drug tools: When your doctor prescribes a new medicine, ask if there’s a generic that will do the same thing. Sometimes a brand name drug is far better than the generic for you, but it’s always worth investigating. Some sites that may help are drx.com, crbestbuydrugs.org, benefitscheckuprx.org.
You can read the WSJ article here, and by all means check out the web site called www.whatsyourgap.com for more information on avoiding the donut hole.
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