The donut hole can be considered as a temporary limitation on what majority of the M.A Prescription Coverages or Part D Prescription Coverages pay to cover your prescription drug expenses. Whilst you are in a donut hole, you may have to pay higher costs for both generic as well as brand-name medications.
Most beneficiaries of Medicare won’t need to cover higher prices within the donut hole period since the costs of their prescription medications are unlikely to reach the initial limitation of $3,700 (for the year 2018).
Individuals eligible for Additional Help will be able to avoid this gap. The program allows people with low income levels pay for Part D Medicare expenses like deductibles, copayments, premiums, etc. People qualify for additional helps won’t have to pay for the donut hole.
Even though many Prescription Drug Coverages under Medicare and Medicare Supplement plan come with a coverage gap, a few of these offer further coverage within the period of coverage gap. The charges for this extra coverage within the donut hole can vary from one plan to other.
The government is reducing the donut hole each year till it minimizes to 25 percent by the year 2020.
It is crucial that you control out of pocket costs for prescription medications so as to avoid the donut hole.
Ways to lower your expenditure on prescription medications:
Most expensive prescription medications have a generic option. Opting for lower-cost medicines can help you stay away from entering the donut hole. Communicate with your physician about the possibility of lower-cost alternatives which might be just as beneficial as brand name medications.
Costs such as coinsurance, deductibles as well as copayments may vary significantly from one plan to the other and might affect your odds of entering the donut hole.
People ineligible for Extra Help can also receive financial help from their drug manufacturer.
In addition, you can find programs that provide pharmaceutical assistance organized by the state government depending on your current location. The programs might help your cover Part D Medicare expenses, and you might become eligible even in case you fail to qualify for Additional Assistance. Check out the official Medicare website for more info.
Last but not the least, taking advantage of Medicare Supplement Plans can allow you to lower your out of pocket Medicare expenses thus helping you avoid the donut hole.