Part D Coverage Gap or “Donut Hole”
Medicare drug plans have a “coverage gap,” which is also been called the “donut hole.” A coverage gap means that after a patient and their plan have spent $2,510 for covered medications, they then must pay out-of-pocket the full price of their medications while they are in the “gap”. The gap ends once they have paid $4,050 in medications for the year. Every Medicare prescription drug plan has a gap in 2008.
There are a few programs and strategies that can be used by seniors to help reduce the costs of medications while in the coverage gap. The programs that provide the best assistance are Medicare’s Extra Help and Prescription Advantage. These two programs reduce the costs for Medicare Part D beneficiaries throughout the year for deductibles, copayments, premiums, and most importantly they provide coverage during the gap. Other programs, such as patient assistance programs through the drug companies that make the medications, can help. Also, co-pay assistance foundations can help lower the costs during the gap. Other strategies such as using a mail order program, visiting a pharmacy with lower prices, and reviewing your medications for lower cost alternatives can also help to lower the costs of monthly prescription costs.
MassMedLine staff can review a patient’s information and list of medications to see which programs and strategies can be used to help. Pharmacists at MassMedLine can review a patient’s list of medications and make recommendations on how they and their physician can discuss lowering their costs by using alternative brand name medications or generic medications.