From the Editor
Donuts and your prescription drugs do NOT go together! What am I talking about here? I just discovered a Medicare Part D coverage gap called a “donut hole”. This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent that year limit, your gap ends and the drug plan helps pay for the covered drugs again.
Most Medicare drug plan a have a “donut hole.” But not everyone will enter the gap. This amount can change each year so it’s hard to plan for. Imagine if you hit the gap when you go to refill an insulin prescription! If you meet certain income levels and resource limits, you may qualify for Extra Help (less than $19,320 income a year and less than $14,790 in checking & savings, stocks and bonds). This program helps pay for Medicare drug coverage, such as premiums, deductibles, and copays or coinsurance costs when you fill a prescription.
In some plans, once you enter the gap, you will pay no more than 25% of the cost for your plans coverage of the drug, plus a dispensing fee.
It may be worth it to shop around for the same drug, without using your insurance. Good Rx offers help. But how do you find out if the price is better than through your insurance without actually filling the prescription first?
You can log into your insurance company portal and search for “Price a Medication” link under your benefits. Be sure and see if you are still under a deductible, which would mean you would pay full price anyway. You may find the medication for half the price at a different pharmacy and will need to use the coupon from the app to purchase it as a “cash” payment. It can be worth trying to see if the out-of-network purchases can apply to your deductible.
80% of a pharmacists time is spent with the insurance company getting the drug covered, etc. Through all this, I see a system that is deeply defective.
So can I take this moment to stand on a soapbox and say how much cheaper & easier it would be if we had a better system.
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