Q & A: Help Filling The 'Donut Hole'

Q & A: Help Filling The ‘Donut Hole’

Q:  I recently discovered that my mother hit the doughnut hole in her Part D drug plan last year and then ran up her credit card to pay for her drugs.  Her Social Security is too low to pay more than the minimum on her credit card and she will need to purchase medications in the coverage gap again this year since she didn't switch plans.  What can we do?

A: There are a number ways to help your mother lower her costs.

  • Some charity programs pay a portion or the cost of the Medicare prescription coinsurance.  The portion these charities pay also counts toward the $3,850 in out-of-pocket costs your mother must spend (not including premiums) before she qualifies for catastrophic coverage.  To find out what programs are available in your area, check the Benefits Checkup website at www.benefitscheckup.org or call your Area Agency on Aging.
  • Major drug manufacturers offer assistance programs for people enrolled in Medicare Part D.  You can find out whether a program is offered by the drugs your mother needs on the Medicare website at www.medicare.gov.  Look for the link to "Lower Your Costs During the Coverage Gap," and look for information about Pharmaceutical Assistance Programs.  You will be directed to a page where drugs are listed by alphabetical order.  Once you select her drug(s), the website supplies the name of the manufacturer, program and contact information.
  • If your mother has limited income and resources, she may qualify for "Extra Help."  The federal program helps pay most, or all of the drug plan's monthly premiums; most, or all of the deductible, if any; and most of the co-insurance or co -payment costs.  If your mother qualifies for full Extra Help she would pay no more than $2.15 for generics and $5.35 for brand-name drugs.  If her income only qualifies her for partial Extra Help she would be able to get reduced co-insurance.  Most importantly for your mother, Extra Help provides full coverage in the doughnut hole coverage gap.  To find out if she qualifies, you need to complete an online screening at Social Security Administration www.ssa.gov.

To learn more about all of these programs and to get other financial counseling advice, we strongly recommend you contact your local Area Agency on Aging.  Their number can be found in your local phone book or call the Eldercare Locator at 1-800-677-1116.

May 2007