Every year hundreds of thousands of people on Medicare reach the Part D donut hole. Although reaching the Medicare coverage gap can hurt financially, there are things you can do to either avoid or delay the coverage gap.
Even though all 2014 Part D plans are subject to the same Standard Benefit Model, the plan you choose can have an impact on the likelihood that you can steer clear of the donut hole.
The following video includes some tips on ways that you can keep your costs down and stay out of the Medicare coverage gap.
Do this to avoid the Part D donut hole
1. Compare plans every year, even if you don’t reach the coverage gap there’s no guarantee that your plan will perform the same next year. Part D plans are effective for one year and benefits, costs and covered drugs may change year to year. If you have been prescribed different or additional drugs, be sure to compare Part D plans and take a close look at the formulary.
2. Use a drug look-up tool. You can do this at medicare.gov or at a plan’s website. Pay particular attention to which tier your drugs are listed in. A drug can be listed in different tiers and have different out-of-pocket costs depending on the plan.
3. Meet with your health care provider to discuss the potential for any less expensive medications that will meet your needs. Be sure to bring your plan’s formulary so your doctor knows which drugs are covered and may be suitable. If you can find less expensive drugs you can increase the likelihood that you avoid the Medicare coverage gap.
4. If you are prescribed a new medication, be sure to ask for some samples. If you can get a couple of weeks worth that will mean that much less you and your plan will have to pay for.
5. Use preferred pharmacies if your plan offers them. Drugs will cost less for both you and your plan if you can use preferred pharmacies. There are several co-branded plans were this strategy can be applied. One example is the Humana Walmart Preferred Rx Part D plan.
6. Continue to show your Part D card even if you have reached the donut hole. Your costs all contribute to the out-of-pocket threshold amount and if your costs are large enough you will exit the donut hole that much sooner and qualify for catastrophic cost-sharing amounts.
Follow these simple tips and you may be able to avoid or at least delay getting into the Medicare coverage gap.