If Medicare wasn’t confusing enough, now we have Medicare drug plans to contend with. Oh, I’m not complaining. I’m thrilled to have the drug coverage. But the whole thing can be a bit daunting.
First, the drug coverage doesn’t automatically come with Medicare. You have to pay a separate premium for it. How much you pay depends on which company you sign up with. It would behoove you to shop around.
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However, the premium you pay isn’t the only thing to consider when doing your shopping. You need to look and see what drugs each company covers. That’s right – each company isn’t required to provide the same coverage. I bet you thought that since this was Medicare they would have to give everyone the same thing, didn’t you? Hardly. The fact is that there are vast differences between companies, and if you take many medications it can mean quite a bit a difference in what you may pay in a given year. If you are healthy and only take one or two medications a month it won’t mean much to you, but if you have significant health issues you need to really be aware of what you’re getting into.
Next, you need to know that the drug coverage has limits. The best way to understand these limits is look at your coverage as being divided into four stages each year. These stages are as follows:
Stage One: At this point you pay 100% of your drug costs until you have paid $310 towards the cost of your medications (these are the figures for 2010 – the numbers change every year).
Stage Two: Here you and the plan together share the cost of your drugs until your payments for the year plus the plan’s payments total $2830. What this means is that you pay a reduced rate for your drugs.
Stage Three: You pay the full cost of your drugs until your “out of pocket costs” reach a total of $4550″. This amount is the same at every company – the amount is set by law.
Stage Four: The plan pays for most of the drug. Your share will usually be 5% of the cost of the drug or $2.50 for a generic drug. The plan will pay for the rest of the cost for the remainder of the year.
Preview of Medicare Drug Plans: Understanding the Donut Hole – Page 2
People usually ask – what is mean by the donut hole? Well, the donut hole is that space of time where you have no coverage at all – it is that stage three period. You quickly got through stage 1 and then the “donut” was stage 2. But then you hit the hole – stage 3. Not very tasty, was
it?
Another question people often ask is how they can save money on their prescription drug coverage. There are a few ways. One is to take advantage of Walmart’s drug program. If you’re not going to go into catastrophic coverage (stage 4), then use there is no reason to use your Medicare drug benefits up on something like potassium supplements when you can get them for $5 a month at Walmart.
Another thing is to remind your doctor of your plight and bug him or her for samples. When your doctor doesn’t have samples ask if a less expensive medication could be substituted. Be aware of the tier system of your Medicare drug program so you’ll know whether you can get something in generic – it never hurts to take the coverage booklet with you to the doctor. However, if your doctor says you must have a particular medication, then by all means, take that medication. Do not tamper with your health by skipping meds or question your doctor’s judgment further. While asking your physician if another, less costly drug, will do just as well for you, is fine, don’t argue once the question has been answered. There is a point you just need to trust your doctor’s judgment or get another doctor.
You might also contact your local Medicaid office and check to see if you qualify for programs called SLMB or QMB. While these income based programs won’t pay for your medications, they help with paying your Medicare premium, and that money could be used to pay to help pay for your medications. >www.medicare.gov
