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 Several Medicare prescription drug plans have a gap in coverage, sometimes referred to as a “doughnut hole.” In 2013, after you have accumulated $2,970 in total covered drug costs (what you and the plan have paid), you pay 47.5% of your covered brand-name drug costs and 79% of your covered generic drug costs until you have spent $4,750 out-of-pocket.
After that, you will have “catastrophic coverage,” where you will pay only 5% of your covered drug costs for the rest of the calendar year.
What Are My Options During the Gap?
1. Keep using your Medicare prescription drug card.
- Plan prices are generally lower than retail cost.
- The money you spend will count toward the $4,750 you need to spend in order to receive catastrophic coverage benefits.
2. Switch to generic or less expensive brand-name drugs.
- Contact your doctor to see if a change is appropriate.
- This could reduce your co-payments and help maximize savings.
3. Explore other available assistance.
- Contact the Social Security Administration to see if you qualify for extra help in paying for your prescription drug plan.
- Look into Prescription Assistance Programs. (See list below)
- Ask your doctor about free samples for your prescription.
4. Review your current plan and do a comparison to determine if you should change to a plan that provides coverage in the gap the next time you enroll. SHIP can help.
Pharmaceutical & Patient Assistance Programs
Partnership for Prescription Assistance
1-888-477-2669 | www.pparx.org
PPARX helps qualified individuals get medicines they need through public or private programs.
Rx for Oklahoma
1-877-794-6552
For more information, contact the Oklahoma Senior Health Insurance Counseling Program (SHIP) at 1-800-763-2828.
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