How to keep the ‘Donut Hole’ from getting you!

Published 12:00 am Wednesday, August 3, 2022

Toni:

            Last year, my mother got into the “donut hole” in October. I can see from the Part D statement she receives that she has hit the donut hole in June of this year. Her prescription drugs have not changed from last year.

             She can afford her co-pays of $180 per month that she pays at the pharmacy. The monthly Part D statement says the prescription drugs retail cost is $802 per month. I am confused.

            Please give me ideas to help control the donut hole cost! Thanks, Jennifer from Dallas, TX

 

Jennifer:

Your mother’s prescription drug problem is a typical problem since the cost of brand name prescriptions has risen dramatically. She can afford her $180 co-pays but has no idea that the actual cost of her prescription drugs is $802 each month.

Once the retail price of her prescription drugs total $4,430 for 2022 for her covered drugs, then she is in the famous “Donut Hole” or coverage gap for her Medicare Part D plan.

She must pay $7,050 retail price to get out of the “Donut hole”. She will pay 25% for a brand name drug, the brand name drug manufacturer will pay 70% of that covered brand name drug and the remaining 5% will be paid by the prescription drug plan which she enrolled in.

What happens if your brand name drug is not a “covered” brand name drug on your specific Part D plan? You will have to pay 100% of that brand name drug cost.

Generics cost less, and for 2022, the cost is a 25% co-pay when in the “Donut hole”. Unfortunately, many brand name drugs do not have a generic alternative to use.

Do research prior to enrolling in a Part D plan because if you choose the wrong plan, you cannot change it until Medicare’s Annual Enrollment Period, which is from October 15 to December 7 every year.

January 1 of each year, the process starts all over again with a new Medicare Prescription Drug plan and different costs, deductibles and a new donut hole.

Toni Says® Tips to help you stay out of the Donut Hole or not get in it as soon!

  • Visitmedicare.gov when selecting a Medicare Part D plan, whether it is your first time or changing during Medicare’s Annual Enrollment Period in the fall.
  • Talk to your Primary Care and specialty doctors about which brand name drugs can be changed to generics.
  • Get samples from your doctor.
  • Search various Prescription drug programs such as GoodRx or Single Care for inexpensive prescription drug cost. HEB, Wal-Mart, Kroger and Costco also have discount prescription drug plans. To get their discounted price, you only need a prescription from your doctor.
  • Sign up for Toni Says® newsletter at tonisays.com to keep up to date on Medicare changes. For answers to Medicare questions, email info@tonisays.com or call 832-519-8664.

 

Toni King, author of the 2022 Medicare Survival Guide® Advanced edition is giving a $5 discount on the Medicare Survival Guide® Advanced book at www.tonisays.com.