There’s been a lot of buzz in the news these past few weeks about our government’s plan to close the gap in Medicare Part D’s prescription medication coverage. So I thought we’d use today’s article to figure out what it means, exactly, to be in the infamous “donut hole.”
Sadly, not this.
If you choose to get prescription coverage under Medicare Part D, you may eventually find yourself in the ‘coverage gap.’ Here’s how that works:
If you get your prescriptions through this insurance program, you generally pay, on average, 25% of your medication costs, plus a deductible. However, after the total cost of your drugs (at retail price) reaches $2830, Medicare stops coverage. You’re on your own, until you’ve spent so much on your medications that you qualify for “Catastrophic Drug Coverage.” The dollar amounts for how much you have to spend before you qualify (as well as before you hit the maximum coverage limit) can change annually, but for 2010, you have to spend an additional $3610 out-of-pocket before you’ve made it across the donut hole and back to the donut, per se. In the “CDC” phase, you are only responsible for 5% of your drug costs for the rest of the calendar year– sweet, indeed!
Getting through that middle stretch, however, is the tough part. But with the passing of the new health laws, the government has laid out a plan to close the gap.
How to Make a Donut Hole Disappear
This summer, they began sending out $250 rebate checks to seniors who found themselves without coverage. The next step in the plan is to finalize a major-money saving deal with Big Pharma. The government just recently allowed the public to get a look at the details of their negotiations with Big Pharma companies like Pfizer, AstraZeneca, and Bristol-Meyers Squibb. The ultimate goal is to secure a 50% discount on brand-name medication drugs for Medicare beneficiaries when they’re in the donut hole.
Finally, the government will begin subsidizing the drug costs of citizens in the donut hole. It looks like they will begin this program in 2013 by covering 2.5% of the price of brand name medications. They will increase the subsidy until 2020, when it will encompass 25% of the cost of branded drugs. The government has a similar plan for subsidizing generic drugs. The ultimate goal is to subsidize 75% of the costs of generic medications by 2020. Between industry-wide discounts and government subsidies, by 2020, seniors who find themselves in the Medicare donut hole will receive help with up to 75% of the costs of their medications.
What to Do Until 2020
In the meantime, check out ProgressiveRX for high-quality medications that are often up to 80% off the price of their brand-name counterparts at your local pharmacy. Thousands of people have turned to ProgressiveRX so they could continue to get the medication they needed at a price they could afford, even without any help from insurance.
Don’t forget to check back here on Friday for a round-up of links for more information about the Medicare donut hole, the new health legislation, and where you can get help navigating your Medicare plan. To have the post delivered to your inbox, sign up for an email subscription over at the top right side of the page, directly underneath our logo.
How about you? Have you or your loved ones ever had to go through the Medicare donut hole? Are you in it right now? Share your story in the comments!
ProgressiveRX 