Check Your Drug Coverage: 2014 Part D Initial Coverage Less Generous

Medicare Part D's infamous drug coverage gap, aka: the "doughnut hole," is slowly closing — a widely touted benefit of the 2010 healthcare law. Several Part D costs, like the "standard" deductible, and the out-of-pocket costs thresholds, will be lower in 2014. But don't be lulled into thinking that most Medicare beneficiaries will see a big improvement in their prescription drug spending. To the contrary, most probably won't. That's because for the first time since Part D started, the initial coverage amount will be less generous — by $120. That means you may hit the doughnut hole coverage gap sooner, paying higher out-of-pocket costs when you do.

Even if your premiums stay similar to what you paid in 2013, you can expect recent trends to continue, like; higher co-pays or new co-insurance, reduced choice in pharmacy networks, more restrictions on covered drugs, and other changes that can significantly increase what you pay out-of-pocket. Here are some of our most popular tips for stretching your Part D coverage:

Six Steps to Getting Six Month's Worth of Prescription Meds for the Cost of Two!

Seniors and the disabled who hit the doughnut hole must still spend $4,550 out-of-pocket in 2014 before they reach catastrophic coverage.

1. Learn your drug plan's full cost and coverage for every prescription you take: If you take more than $237 worth of prescription drugs a month, you're at risk of hitting the doughnut hole at some point during the year. The $237 is based on the full retail cost, which is what you and your drug plan pay, not your co-pays. In other words, you may be spending as little as $60 in co-insurance or co-pays per month and be at risk of hitting the doughnut hole. Part D plan enrollees have an initial coverage limit of $2,850 in total drug costs (what you and your plan pay) in 2014. You can learn the full cost of your drugs and whether your plan covers all your prescriptions using the Medicare Drug Plan Finder at www.Medicare.gov. On the Medicare.gov homepage, click on the link to "Find health and drug plans". View videos to learn how to use the tool or dive in by using the "Personalized Search." You will need your Medicare number.
2. Estimate your costs and when you may risk hitting the doughnut hole: Based on the prescriptions you enter, the Medicare Drug Plan Finder can estimate your annual costs. Once you reach your health plan (or the results of the plan search) make sure you are looking at plan information for 2014. Look for tabs and links providing "your plan details." Scroll to find "What you will pay" information for your prescriptions and look for the "full cost of drugs." Divide $2,850 by the monthly amount of your full cost of drugs to get the number of months until you reach the doughnut hole. If 12 or more, you may not hit the gap as long as your health doesn't change.
3. Find out if there are less costly options you can try: If you learn you are taking an expensive drug or one that's not covered by your drug plan, call your doctor to find out if there are generics or older, less expensive drugs that you could try.  When trying out a new prescription ask your doctor for free samples, to allow time to determine whether it will treat your condition as effectively, and to monitor for potential negative side effects.
4. Find out if your drug plan offers mail order: If your drug plan offers mail order, you can often significantly cut your costs by using it. Generally, mail order requires a 90-day prescription, but often your cost is similar to what you would pay for a 60-day supply from a retail pharmacy.
5. Split your pills if you can: You can sometimes cut your costs in half by splitting your pills in half, if they are the type that can be split. Ask your doctor if pill splitting would work with your prescriptions. Your doctor may need to write a prescription with a higher dosage than you normally take. You can readily find inexpensive pill splitters at your pharmacy. If you do split your pills, make sure your family and emergency caregivers also know! You may want to split all your pills as soon as you get them, or carefully label all prescriptions that require splitting.
6. Compare generic costs: You sometimes pay more for common generics using your drug plan than you would simply by visiting a pharmacy with a $4 generic program. Compare the costs first. If the $4 generic saves you money over your normal co-pay, put your drug plan card away and shop at the discount pharmacy. Save your coverage for more expensive prescriptions.

Print