Down the Donut Hole!
Almost all plans with Medicare prescription drug coverage (Part D) have a donut hole. A donut hole is basically a coverage gap that occurs after you and your drug plan have spent a certain amount of money for covered drugs. Once this happens, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have reached that yearly limit, your coverage gap ends and you drug plans kicks in again to help pay for covered drugs.
Let’s break this down into dollar amounts for 2014
The Donut hole phase of your part D Medicare Coverage begins when your total retail drug costs reach $2850.00.
$310.00 (the initial deductible) and $2540 = $2850.00.
Lots of seniors find that their medications easily exceed $2850.00 on an annual basis. What happens then?
Once you reach the $2850.00, you will have fallen down the donut hole. Here’s how you get out:
Everyone who falls down the donut hole must spend $4550 out of their OWN pocket in order to get out of the donut hole (the coverage gap)
Once you reach $4550.00 out of your own pocket, you will have climbed out of the donut hole. You now enter what’s called “catastrophic coverage.” Once you reach catastrophic coverage, you are only responsible for a small copay for all of your medications until the end of the year. January 1 starts the process all over again. The donut hole can change from year to year and so can your prescription drug plan.
*The only additional cost you are responsible for is whatever your monthly premium is for your part D prescription drug plan.
How to keep from falling into the donut hole or not fall in as quickly!
1. Whenever you can, get samples of your medicines from your doctor.
2. Whenever possible (always with your Doctor’s approval) use generic drugs instead of brand name drugs.
3. Walmart and Kroger (among others) have generic prescription drug programs. Check with these places and price your medications there.
4. Use your Medicare Part D for your more expensive brand name and generic drugs.
If you have more questions regarding the donut hole, please feel free to contact me directly at [email protected].
Let’s break this down into dollar amounts for 2014
The Donut hole phase of your part D Medicare Coverage begins when your total retail drug costs reach $2850.00.
- *This $2850.00 is the total cost of your covered medications, not just what you spend personally at the pharmacy.
- *You will pay a part of the $2850.00 and your part D pays a portion.
- * You pay the first $310.00 as the initial deductible.
- *After you pay the first $310.00 (the initial deductible) you will pay 25% of the remaining $2540 which equals $635.00.
$310.00 (the initial deductible) and $2540 = $2850.00.
Lots of seniors find that their medications easily exceed $2850.00 on an annual basis. What happens then?
Once you reach the $2850.00, you will have fallen down the donut hole. Here’s how you get out:
Everyone who falls down the donut hole must spend $4550 out of their OWN pocket in order to get out of the donut hole (the coverage gap)
Once you reach $4550.00 out of your own pocket, you will have climbed out of the donut hole. You now enter what’s called “catastrophic coverage.” Once you reach catastrophic coverage, you are only responsible for a small copay for all of your medications until the end of the year. January 1 starts the process all over again. The donut hole can change from year to year and so can your prescription drug plan.
*The only additional cost you are responsible for is whatever your monthly premium is for your part D prescription drug plan.
How to keep from falling into the donut hole or not fall in as quickly!
1. Whenever you can, get samples of your medicines from your doctor.
2. Whenever possible (always with your Doctor’s approval) use generic drugs instead of brand name drugs.
3. Walmart and Kroger (among others) have generic prescription drug programs. Check with these places and price your medications there.
4. Use your Medicare Part D for your more expensive brand name and generic drugs.
If you have more questions regarding the donut hole, please feel free to contact me directly at [email protected].
