Ask The Advisor: October 2011

Ask The Advisor: October 2011

Q: Part D fails enrollees who must take very expensive drugs. We fall into the “doughnut hole” and then either have to pay up to $3,850 out-of-pocket until catastrophic coverage starts, or fail to take our prescribed medication. How am I supposed to afford over $3,850 in medicine when I only receive $1,174 a month in Social Security?

A: Part D only provides meager coverage for Medicare beneficiaries who take expensive prescriptions. Seniors and the disabled who must use expensive medications can run through the initial coverage limit, which was $2,400 in 2007, in just a few months, leaving beneficiaries to pay 100% of the cost of drugs until they have spent a total of $3,850 out-of-pocket. And this does not include premiums.

To date no legislation has been signed into law to close the doughnut hole coverage gap.
There are several ways to lower your costs that you should look into:

1. Apply for “Extra Help.” If you are living on less than $1,276 a month ($1,711 for couples) in 2007, and have only modest savings, you may qualify for “Extra Help,” the federal government program that provides assistance with some or most of the Part D drug costs, including the doughnut hole coverage gap. Enrollment is not automatic, you must apply through the Social Security Administration. Call 1-800-772-1213, or apply online at

2. Talk to your doctor to find out if there’s a generic or less expensive drug. Your drug plan has several “tiers” of pricing. Generics are priced the lowest, then “preferred” drugs, “non-preferred” and “specialty drugs.” You can considerably lower your cost if your doctor prescribes a drug that’s on your drug plan’s “preferred” or generic list.

3. Look for better coverage and a less expensive plan. Unless you selected the Part D drug plan that you’re currently enrolled in by using the Medicare Drug Plan Finder data base found on, chances are you pay much more for your coverage and drugs than you have to. November 15 through December 31 is your chance to switch to a drug plan that offers better coverage at a better cost. I strongly recommend that you get the help of an unbiased, trained Medicare benefits counselor through your State Health Insurance Assistance Program. The service is available at no charge through many Area Agencies on Aging. The counselor will help you review your current coverage and determine if there’s a more affordable choice for you.

4. Use mail order for drugs you take on a regular basis. You can significantly cut your out-of-pocket costs, as much as 20%, by choosing a drug plan that offers a mail order option instead of making monthly visits to retail pharmacies.

Sources: “Some Seniors Still Vulnerable To High Costs, Study Finds,” Kaiser Daily Health Policy Report, August 21, 2007.