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Top 6 Ways to Avoid the Medicare Part D Donut Hole

According to the Mayo Clinic, over 60% of Americans take at least one prescription drug. About 20% of patients take five or more prescriptions. Whether you take one or multiple medicines per day, consider enrolling in Medicare Part D. Medicare’s prescription drug coverage can help you pay for medications, as Original Medicare doesn’t cover most of the drugs you take at home.     

You can buy a separate Part D plan if you have Original Medicare, or you can get it through a Medicare Advantage (Part C) plan that has built-in prescription drug coverage.

Remember That Part D Coverage Isn’t Free.

Having health insurance doesn’t result in free coverage, but it does lower your out-of-pocket costs. Medicare Part D plans come with premiums, deductibles, and copayments/coinsurance, which can vary from plan to plan. 

Related Post: Prescription Drug Tiers

What Is the Coverage Gap, AKA Donut Hole?

You enter what’s called the coverage gap once you and your Part D plan have spent a select amount on covered prescriptions. When you’re in the coverage gap, you’re liable for a more significant percentage of your medications’ costs. 

You Want to Avoid It.

No one wants to overpay for Part D coverage. Also, everybody wants to avoid the “donut hole.” Trusted Senior Specialists has assembled a quick list of ways you can do this to save on prescription drug costs.

Knowing how to avoid the coverage gap will allow you to save money. Keep in mind that not all of these options will apply to everyone.

How to Avoid the Coverage Gap

  1. Compare Drug Plans Each Year

During Medicare’s annual enrollment period, you have the opportunity to change your Part D coverage. While you’re not required to change plans, it always helps to compare your options. Plan benefits vary every year, and you need to know that you’re saving as much as possible.

  1. Consider Changes to Your Lifestyle

Next, visit your doctor and ask how you can improve your health. Ask about medications you could break away from if your conditions get better. Depending on the plan you have, your coverage might include a gym membership and other additional benefits.     

  1. Use Generic Versions When Possible

Brand name copays are often much higher than their generic match. Also, the retail cost is the amount that applies to the coverage gap. Even if you’re paying $40, if the medication costs a total of $200, then $200 contributes to the amount that places you in the donut hole. 

Some generics with certain policies are $0, and many come with a small retail cost. You can switch to the generic version of your medication — talk to your doctor about it.

  1. Price Check Drugs Online

Perhaps the easiest way to avoid the donut hole is to check the price of your drugs online. You won’t save money on every medication, but every dollar counts. Some medicines are cheaper without insurance, and those can save you in a couple of ways. You save on the medication’s direct costs, and those costs won’t go towards the coverage gap.   

Related Post: What Is a Formulary and Why Is it Important?

  1. Compare Pharmacies

Did you know that the same medication may vary in cost at different pharmacies? It makes sense to either:

  • Choose a plan that works with your pharmacy, OR
  • Change your pharmacy to one that’s best suited to your policy.

If this sounds like a tall task, work with an agent at TSS. We can help you find the ideal pharmacy and policy combination. 

  1. Think About Applying for Extra Help

Last but not least, if you have a low income, you should apply for Extra Help. If eligible, the program will chip in to pay premiums, coinsurances, and copays on medications. Additionally, there’s no coverage gap for those who get assistance.

Call Trusted Senior Specialists

We hope this info helps you save money on prescription drugs. At Trusted Senior Specialists, we help our clients find the best coverage for their situation. We can also identify the most affordable Part D and Medigap plans. To learn more, call (855) 952-1941 or contact our team online.