AP NEWS

Is the Medicare donut hole getting you?

August 2, 2018

Last year, my mother got into the “donut hole” in October. I can see from the Part D statement she receives that because her total monthly drug cost is $950 per month and she is rapidly approaching the donut hole. This is only the beginning of July. She can afford her co-pays of $180 per month that she pays at the pharmacy but what the cost will be when she reaches the “donut hole” is unaffordable. Please give me some ideas to help control this cost! Her prescription drugs are the same as last year.

Thanks.

Jennifer from Dallas, TX

Jennifer:

Your mother’s prescription drug problem is a typical problem since the cost of brand-name prescriptions has risen dramatically. She can afford her $180 co-pays, BUT … has no idea that the true cost of her prescription drugs is $950 each month.

Once her Medicare Part D prescription drug plan and the co-pays she pays total $3,750 in 2018 for her covered drugs, then she is in the famous “donut hole” or coverage gap.

She must pay the next $5,000 to get out of the “donut hole.” She will pay 35 percent for a brand-name drug and the brand-name drug manufacturer will pay 50 percent of that covered brand-name drug. Now the remaining 15 percent will be paid by the prescription drug plan which she enrolled in.

What happens if your brand-name drug is not a “covered” brand name drug on your specific Part D plan? You will have to pay 100 percent of that brand-name drug.

Generics cost less than brand-name prescriptions, but in 2018, the cost is a 35 percent co-pay when in the “donut hole.” Many brand-name drugs do not have a generic alternative to use. So, you do not have another option to pick from.

That is why it is important when choosing a Medicare Part D prescription drug plan, whether beginning Medicare for the first time or during fall’s Medicare’s annual enrollment, to be sure all prescriptions are covered on one’s Part D plan.

Do research prior to enrolling in a Part D plan because if you choose the wrong plan, you cannot change it until Medicare’s annual enrollment period (aka Open Enrollment), which is from Oct. 15 to Dec. 7 every year.

Jan. 1 of each year, the process starts all over again with a new Medicare prescription drug plan and different costs, deductibles, and a new donut hole.

Visit ABBS4U.com for tips to help you stay out of the donut hole or not get in it as soon.

1) Visit www.medicare.gov when selecting a Medicare Part D plan.

2) Talk to your doctor or doctors about which brand-name drugs can be changed to generics.

3) Get samples from your doctor.

4) See what generics are in a $4 or $5 generic prescription drug programs at H-E-B, Wal-Mart, and Costco etc.

5) Contact the Prescription Assistance Program in Lake Jackson at 979-285-1430, which has saved over $64 million helping people get their prescriptions at affordable prices when they can’t pay for them.

6) Visit the new Medicare help site www.abbs4u.com and enroll in the online Medicare tutorial courses which can help you understand various options with Medicare and a specific course for Medicare Part D and how to find the right Part D plan to fit your needs.

Coming in August

Confused about Medicare Webinars and to register visit www.tonisays.com and click on the Webinar tab. Watch a Toni Says® Confused about Medicare workshops in the comfort of your own home or office setting.

Toni King, author of the new Medicare Survival Guide® offers a Toni Says® Medicare column readers discount available at www.tonisays.com. Email Medicare/long-term care questions to info@tonisays.com or call 832-519-TONI (8664).

info@tonisays.com