There is no such thing as Donut Hole Insurance. You cannot specifically buy a plan just to cover the Medicare donut hole. However, this doesn’t mean you will be paying full price for your medications. When you reach the coverage gap, the insurance company still has to discount your medications significantly. That discount will grow in your favor between now and 2020 as well.
Also, remember that the total cost of your medication is what is counted toward the point when you will reach the coverage gap. You can help lower this amount in several ways:
- Speak with your physician about lower-cost alternative medications that may exist to treat the same condition. Even if your current medication does not have a generic equivalent, there may be other medications that treat the same condition that are less costly.
- Use your drug plan’s mail order service. Drugs purchased through mail order often have lower total costs than drugs bought at a retail pharmacy. This means the amount applied toward your Part D initial coverage limit is lowered. Some carriers offer medications as low as $0 for generics when ordered through the insurance company’s mail order program.
- Fill your prescriptions at preferred pharmacies. Some Part D drug plans have both preferred and and standard pharmacies. All of the pharmacies are in the plan’s network, but your costs at preferred pharmacies will be lower, sometimes considerably lower.
- Research pharmaceutical assistance programs. Both the drug manufacturers and your state assistance programs may offer help for certain expensive medications. There are also charitable organizations like the National Patient Advocate Foundation, that may be able to help. You can apply for this assistance to see if you qualify to be given the drug at a much lower copay. Qualifications are often based on your income.
- Take advantage of your pharmacy’s own drug program. Certain pharmacies, such as Wal-mart, have lists of generic medications that you can purchase without insurance for only $4. Buying these medications outside of your drug plan means they won’t count toward your Medicare Donut Hole. Get into the habit of asking your pharmacist to tell you the cheapest way available to you to fill each medication.
- Veterans Association. If you served, you may qualify for inexpensive medications through your local VA hospital or clinic. Contact the VA to find out.
- Apply for the Low Income Subsidy. Medicare has savings programs that can help you with your drug costs. The Low Income Subsidy can reduce your premiums and eliminate your deductible and coverage gap if you qualify.Contact Social Security at 1-800-772-1213 for an application.
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