For those who have enrolled in Medicare Part D, this is the time when many will enter the so-called “donut hole” where the plan requires you to pay all of your prescription drug costs.
On January 1, 2006 the United States government launched its Medicare Part D program. The plan is designed to assist those who are Medicare eligible afford the ever increasing costs of prescription drugs. For many, this plan has been a blessing. For others, Medicare Part D is a confusing program too complicated to understand.
The basic plan involves a premium averaging $35 a month. You will have a deductible of $250. This means you will pay the first $250 of all your drug costs before the plan will begin paying. Medicare Part D will then pay 75% of your prescription costs until you pay another $500 out of your own pocket. You then enter the dreaded “donut hole.”
You are now required to pay all of your prescription drug costs until you pay another $2,850. If you make it through this “donut hole,” you will have paid $3,600 out of pocket expenses so far this year for prescription drugs.
Many Medicare Part D recipients have budgeted for their prescription drug costs during the previous months when they were paying just 25% of their total drug expenditures. Now, suddenly, they are required to pay the full cost and are having difficulty.
Some calculations are now required to determine how long you will be in the “donut hole.” The first step is to find out how much you are going to be spending every month on prescription drugs while you are in the “donut hole” (the full cost of the medication). Multiply how much you are spending every month by the number of months remaining in the year. If this number is over $2,850, you will make it out of the “donut hole” by the end of the year. After you have spent another $2,850, the Medicare Part D plan will pay 95% of your drug costs, leaving you with just 5% of the costs for any remaining months of the current year.
If your figure is less than $2,850, you will not make it through the “donut hole” and will be required to pay all of you drug costs until January 1. Creative techniques for lowering your drug costs should now take place to help ease this expense.
If you have been taking the same medication for at least six months, you may want to consider buying in bulk. Pharmacies charge a dispensing fee every time you get your prescription filled. This fee is added on to the cost of the actual pills. The more pills you buy at a time, the lower the cost-per-pill. Your Medicare Part D plan may not pay for more than a thirty day supply. You are not required to use your plan and not using your plan may be beneficial if you will be remaining in the “donut hole” through the end of the year. Simply tell your pharmacist that you want the price for a 90-day supply of your medication. You will see that this will be less than three times the 30-day supply price.
You can make your pharmacy experience less aggravating by having all your prescriptions due at the same time. This requires some figuring to determine how much of each medication you will have to buy. You will want to have the same number of pills for each of your prescriptions. This allows for fewer trips to the drug store and less hassle.
One of the most popular money saving techniques is cutting your medication in half. Prescription drug prices do not double with a doubling of the dose. In fact, often times the price does not increase much at all. Check with your pharmacist if your medication can be cut. If so, ask your doctor to call the pharmacy for twice the dose and take one-half tablet. You can save almost 50% by just cutting your tablets in half.
You should always get the generic medication when available. Generics are just as effective as the more expensive brand name drugs. The Food and Drug Administration regulates all prescription medication and generics must be equivalent to their brand counterparts. Generics are much less expensive because the patent has expired and several drug manufacturers can compete, bringing the price down.
If you are currently enrolled in Medicare Part D and have not reached your “donut hole,” get ready. Do not be shocked when you go into your local pharmacy and the cost is much more than you are used to paying.
Try to use the money saving techniques laid out here. It may be a little difficult in the beginning but the savings are real. It is not the pharmacy’s fault; you have entered into…the donut hole.