When Am I In The Coverage Gap For Medicare Prescription Plans?

The Part-D Prescription Drug Program is now well within its fourth year after going into effect on January 1, 2006 and many Medicare recipients have found a number of reasons to be disgruntled and fearful. Their greatest fear is finding themselves in the dreadful coverage gap, also known as “the donut hole.” Why?

Reaching the Coverage Gap for Medicare Prescription Plans

According to the Medicare Prescription Drug, Improvement, and Modernization Act or MMA, you will reach the coverage gap once you have spent a little over $2800 for prescription medication. However, it should be noted that the complete retail price for medication is used to determine the amount towards the coverage gap limit and not the co-pay balance that some Medicare prescription plans provide. Taking this into consideration, it’s rather simply to see how a two or three brand name medications could place you in the coverage gap.

Here are two techniques everyone under Medicare Prescription Plans should consider:

Generic Medication

Consult with your physician about the possibility of using a generic alternative medication as a replacement for the brand name. Using generic medication that works just as well as brand name medications can help save you hundreds and possibly even thousands of dollars on Medicare prescription plans.

Under-Priced Generic Drugs

Avoid using Medicare prescription plans for under-priced generic drugs. Most pharmacies offer these medications at relatively low prices; however, when you present your card, it allows the pharmacist to file a claim with the insurer causing the full retail price of the drug to be applied towards the coverage gap. Many Medicare recipients aren’t aware of these two techniques, let alone others that can help them avoid the dreaded “donut hole.”

Comments are closed.