The Donut Hole

My wife takes 6 different prescriptions, and hit the donut hole in April. We have to pay close to $5000 before coverage will be picked back up. This is a great expense to us and we had a very hard time with it. We did go back to the Doctor to see if there were alternative medication that she could take that would be less expensive. Unfortunately this was not the case. We then heard about your service and are happy to say that with a savings of more than 50% and the advice you gave us in going to Wall Mart for 2 of the 6 medications, we are able to afford his medications. I am happy to have this heavy burden lifted. Peter C.

Many of our customers are Senior Citizens and qualify for Medicare. Medicare Part D is the current plan that covers prescription medications. The plan is designed to help cover the cost of medication. The plan however, has a coverage gap also known as the “donut hole” – this is where many of our customers come to us to help put the pieces of this puzzle together. The below is a chart of how the plan works, and illustrates how the gap works, what it takes to get into it and more importantly what Seniors need to spend to get out.

Taken from 2011 U.S Government Official Medicare Handbook – Page 77

Monthly Premium—Ms. Smith pays a monthly premium throughout the year.

1. Yearly Deductible

2. Copayment or
Coinsurance
(What you pay at
the pharmacy)

 

3. Coverage Gap 4. Catastrophic
Coverage
Ms. Smith pays the
first $310 of her
drug costs before
her plan starts to
pay its share.
Ms. Smith pays a
copayment, and her
plan pays its share
for each covered
drug until their
combined amount
(plus the
deductible) reaches
$2,840.

Once Ms. Smith
and her plan have
spent $2,840 for
covered drugs, she
is in the coverage
gap. In 2011, she
gets a 50% discount
on covered brandname
prescription
drugs that counts as
out-of-pocket
spending, and helps
her get out of the
coverage gap.

 

Once Ms. Smith
has spent $4,550
out-of-pocket for
the year, her
coverage gap ends.
Now she only pays
a small copayment
for each drug until
the end of the year.
 

 

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