If you have a Medicare Part D plan for your prescription drugs, you may get a surprise at the pharmacist: The drug you were taking that has been covered all year suddenly isn't covered anymore. Your pharmacist will charge you more for the drug. If this happens to you, you've probably run into the Medicare Part D coverage gap, often called the "donut hole."
Here's how it works: Once you and your plan have spent a certain dollar amount within a calendar year, coverage ceases. You'll have to spend more for drugs out of pocket, or find some other resources, until you hit a catastrophic coverage threshold. At that point, Medicare Part D will cover your prescription drugs again, as it did before. As of 2018, you'll run into the donut hole once you've spent $3,750 in prescription drug costs. Once you hit that threshold, your coverage decreases, and you will need to pay 35% of the cost of brand-name drugs and 44% of the cost of generics. You'll continue to be charged this amount until you reach the catastrophic coverage threshold of $5,000 on prescription drugs during the calendar year. Once you have emerged from the donut hole and you are in the catastrophic coverage phase, you will be charged not more than 5% of your prescription drug costs from that point. The good news: Things will improve next year, when Part D beneficiaries will only have to pay 25% of drug costs while in the coverage gap. That's because pharmaceutical manufacturers currently pay 50% of brand-name drug costs while customers are in the donut hole. Under a law passed in February 2018, these pharmaceutical companies will begin paying 70% next year. How to Reduce Drug Costs
Note: Don't stop paying Medicare Part D premiums. If you cease doing so, you could get disenrolled from the program, and be subject to a permanent late-enrollment penalty when you try to sign up again. Finding Assistance If you or a loved one are having trouble paying drug costs while in the donut hole, contact the National Council on Aging (NCOA.org) which runs 69 Benefits Enrollment Centers nationwide. Counselors at these centers may be able to help you enroll in a number of state or local programs that may help you cover your drug costs.
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Rod Hanks
Rod has owned The Hanks Group, a Leading Nationwide Insurance agency since 1999. We help families and business owners protect their most valuable assets with a broad range of insurance products. We believe that finding the right auto, home, life and commercial insurance for our clients Starting out with 1 employee in a small office in East Dallas, The Hanks Group has grown to be one of the largest Nationwide Insurance Agencies in the Dallas Fort Worth Metroplex, with offices in Dallas and Fort Worth. Rod is always available to answer any questions about insurance or business at 214-275-8372 Archives
October 2018
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