Basically the Medicare Part D doughnut hole is a brief, yet potentially costly gap in your Medicare Part D drug coverage. While this gap is explained in all Medicare Part D literature and advertising, it’s still a shock when our Explanation of Benefits advises us we’ve reached our plan limits. This gap in time, the period when you’re responsible for 100% of your drug cost, has come to be called, the “doughnut hole”.
There is a spoonful of sugar to help the medicine go down. As stated in the Medicare.gov website, “The Affordable Care Act includes benefits to make your Medicare prescription drug coverage (Part D) more affordable. If you reach the coverage gap in your Medicare prescription drug coverage you’ll get the following:
- A discount on covered brand-name drugs when you buy them at a pharmacy or order them through the mail.
- Some coverage for generic drugs. You can expect additional savings on your brand-name and generic drugs during the coverage gap over the next several years until it’s closed in 2020.
At the outset, when it’s time to enroll in a plan it’s important to compare your coverage options. Each Medicare drug plan provider has it’s own benefits and coverage terms with deductibles and limits. When shopping for your plan, compare offers one against the other, to determine the plan which offers you the best coverage for your individual needs.
Hitting the doughnut hole happens after you and your drug plan have spent a certain amount of money for covered drugs. When this happens you have to pay the full costs of your prescription drugs up to a certain limit (refer to your policy for your plan’s limits).
During each month you have a prescription filled your drug plan sends you and Explanation of Benefits notice, which you’ll often see or hear shortened to EOB. This monthly EOB form tells you how much you’ve spent during the month on covered drugs and if you’ve reached your coverage gap, signalling you’re now responsible for the entire cost of drugs for the remainder of the year. It’s human nature, no matter how well informed we were when we read the plans fine print, it’s always a shock when prescription payments abruptly end. Out of pocket costs, especially on a fixed income, are always a bitter pill to swallow.
“There is no disputing the fact that American consumers pay 30 to 300 percent more for the same prescription drugs as our counterparts in Canada, Europe, and the rest of the world.” ~ Michael K. Simpson
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