Good article written by a senior with some good advice on handling the donut hole..and today if you make an error and find yourself not covered, keep in mind you can perhaps find some of these medications covered for $4.00 via the retailers linked on this page. 

As a senior in this community, I have had to educate myself on the complexities of the Medicare Part D drug insurance.

I spent much time and research on this very complicated topic and I thought that I understood the issues well. But, of course I did not.

Here are two matters to be careful about as you purchase your drugs on this program:

1. The insurance companies will charge you for a full month's co-pay, even if you purchase less than one month of drugs; even only a few days' worth. The insurance companies do not state this in their literature. Indeed, the wording would indicate otherwise. So buy your drugs in monthly increments.

2. Crossing the boundary into the so called "doughnut hole" brings with it several pitfalls. This is due to the fact that the computation of total drug costs is not based only on how much you spent previously. Rather, it includes the new purchase as well. Here is a hypothetical example (numbers will differ for different plans, but the principle holds for all):

Total combined drug payments for you plus insurance is $2,120.

The initial coverage limit is $2,400, after which you pay 100 percent of the cost, while you pay only a $28/month co-pay for Tier-2 drugs before you reach your limit.

You order 3 months of a Tier-2 drug with a total drug cost of $100 per month.

This adds an additional total cost of 3 x $100, or $300.

You are now over the $2,400 limit with $2,120 + $300 or $2,420 and the insurance company will charge you the full $300 for your purchase.

But you will pay only $28 per one month of drugs if you order drugs for only two months and your total cost is $2,120 + $200 or $2,320, which keeps you under the $2,400 limit.

You then order for one more month for which you will be charged the full $100.

You now have three months of drugs at a cost to you of 2 x 28 + 100 or $156, rather than the $300 that the insurance wanted to charge you at first.

There are additional complications that cause you to pay more than you might think, such as paying the full price of $100 for the last month, even though you are $80 under the "doughnut" limit of $2,400.

These matters are quite complex and very difficult to deal with. But you will be ahead financially if you watch out for the above two issues.

Source: Jewish Review: Mastering Medicare Part D details can help save on prescription costs


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