The Doughnut Hole in the Medicare Part D Prescription Drug Program: What You Should Know for 2009
79The "doughnut hole" in the Medicare Part D prescription drug program is not getting any smaller in 2009. For those on the drug plan D who have high prescription drug costs, you're out of luck getting coverage when you reach the coverage gap. In 2009, this gap, or "doughnut hole" as it's called, is the amount you pay above $2,700 in drug costs and below $4,350 out of pocket.
What does this mean? Well, besides paying for the cost of the prescription drug plan plus your copayment or coinsurance on drug costs to $2,700 (that number includes both what you've paid and what the plan has paid), you're now paying 100% of your drug costs until you've dug deep into your pocket and shelled out $4,350, including your deductible and copay (but not the cost of the plan--that, unfortunately, doesn't count toward the limit).
After you've paid $4,350 out of pocket, you're in better shape, since you're on catastrophic drug coverage for the rest of the year and only responsible for 5 percent of your prescription drug costs.
All told, the annual dent in the budget of a senior or disabled person whose drugs are costly is significant and scary.
How to Find Plans That Cover Your Prescription Drugs
Use Medicare's Prescription Drug Plan Finder to find plans that may be a better match for your needs. Unfortunately, not many plans offer coverage in the "donut hole"--and those that do only cover generic drugs. But you may find plans that have better coverage for the prescription drugs you take and that have pharmacies available in your area.
The Annual Enrollment / Election Period for Medicare Part D
From November 15 through December 31 every year, you may switch to a different Part D plan for the next year, starting in January
What Options Do You Have if Your Medicare Program Has a Coverage Gap?
It's not a pretty picture, but there may be options for you to cover you during the period of the doughnut hole coverage gap.
For those patients who are on the prescription drug program (Part D) with a coverage gap, Medicare recommends you:
- Switch to lower-cost medications or generic drugs, if your doctor thinks they would work as well.
- Seek out local or national charity programs--for example, the National Organization for Rare Disorders--which might have programs that could belay some of the drug costs.
- Seek out any assistance programs offered to Medicare Part D patients by the pharmaceutical companies.
- Get Extra Help from Social Security--you may be eligible if you have a low income and savings. Visit Social Security's website, or call 1-800-772-1213 or TTY 1-800-325-0778. If you qualify for Medicaid as well as Medicare, you automatically are eligible for Extra Help.
The Doughnut Hole: Medicare Part D in the News
- Betterthanmedicare.com helps plug the "donut hole", offers discounts on drugsNews-Medical-Net5 days ago
With his proposed health care reform plan, President Barack Obama has set his sights on cutting name-brand prescription drug costs by 50 percent for Medicare patients who fall into the "Part D" coverage gap, universally known as the "donut hole." Plan advocates rave about the potential cost-cutting and feel it's a promising start to health care reform.
- Senior health spotlight - New Medicare Part D coming in 2010Denison Bulletin & Review11 hours ago
The new year is just around the corner, and for people on Medicare, the last two months leading up to 2010 are particularly important.
- Medicare open enrollment: time to make sure you're in the right planPurcell Register3 days ago
(ARA) - Of the more than 45 million people relying on Medicare for health care coverage, many may be paying for a plan that doesn't meet their needs or is too expensive.
Medicare Part D Research
- Medicare Part D offers template for success.
Related Articles Medicare Part D offers template for success. Manag Care. 2009 Sep;18(9):35-6, 41-2 Authors: Merritt M PMID: 19886207 [PubMed - in process]
- Medicare Part D in the face of health care reform.
Related Articles Medicare Part D in the face of health care reform. Am J Pharm Educ. 2009 Oct 1;73(6):112 Authors: Fincham JE PMID: 19885081 [PubMed - in process]
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