Medicare Part D is supposed to provide seniors with access to affordable medicine, and for most people it does. But each year about one in four recipients runs into something called the doughnut hole.
Despite its sweet-sounding name, the doughnut hole is anything but. It's actually a gap in coverage until you reach the maximum out of pocket amount or the next calendar year. Once you've spent the maximum allowable amount - currently $2,700 - all prescription coverage is halted, even though you're still paying premiums.
This can be devastating for many. More than three million people stop taking their medications once they hit the doughnut hole.
There's an exception to this coverage gap, but it's hardly a bright spot. If you spend an additional $6,153 of your own money, then you qualify for catastrophic coverage. At that point, Part D kicks back in and you're covered for the rest of the year.
But for most people, $6,153 is way too much. That's why it's important to steer clear of the doughnut hole, or least put it off as long as you can. The key is to plan ahead. Don't wait for coverage to end before taking action. Start now and develop a comprehensive strategy.
Work with your doctor
Does the doctor have free samples you can take? Can some of your prescriptions be combined? Are there cheaper medicines that do the same thing? Ask your doctor if a generic medication might work as well as a name brand one. Can you buy a higher-dosed prescription and split it? Often a higher-dose pill costs almost the same as a lower-dose one. Shop smarter
Try to find a discount pharmacist. Compare prices on an online mail-order drug store. But use caution when you buy medicines online. To be safe, buy only from pharmacies in the U.S. that are state-licensed. Look for sites that have the VIPPS seal from the National Association of Boards of Pharmacy. See if you can buy your prescriptions in bulk. Check the prices at your grocery store pharmacy. Remember to ask for generic medicines. Check into member discounts. For example, AARP has a prescription drug program that can save members as much as 50 percent on some drugs. Ask for Extra Help Extra Help is a Medicare prescription assistance program for low-income seniors. It's possible to qualify for either full or partial Extra Help, and both are a good deal. The premiums are lower and you're exempt from the coverage gap. Call your local Social Security office and see if you qualify. Don't just assume you're ineligible. You might not be.
Sometimes it happens anyway Even with the best of planning, though, it's still possible to fall into the doughnut hole. If that's the case, don't panic. With any luck, it will be very late in the year. If not, you might be able to find some financial help in other places. Look into:
State-sponsored pharmaceutical assistance programs Medical charity programs Hospitals with charity care policies Pharmaceutical companies with patient assistance programs Getting into one of these programs may take some legwork, though. So start early and be diligent. Go online and start researching well before you hit the coverage gap. The rewards are worth it.
If worse comes to worse, though, you'll need to have funds on hand to cover your prescriptions. You may find yourself cutting corners in other areas of your budget. You might even have to dip into savings or ask family members for help. Whatever it takes, try to keep taking your medicines. Remember, you just have to hold out until January.
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