Last year, my mother got into the “donut hole” in October. I can see from the Part D statement she receives that she has hit the donut hole in June of this year. Her prescription drugs have not changed from last year.Advertisement.
She can afford her copays of $180 per month that she pays at the pharmacy. The monthly Part D statement says the prescription drugs retail cost is $802 per month. I am completely confused!
Please give me ideas to help control the donut hole cost!
Jennifer, from Dallas
Your mother’s prescription drug problem is a typical problem since the cost of brand name prescriptions has risen dramatically. Sure, she can afford her $180 copays, but has no idea that the actual cost of her prescription drugs is $802 each month!
Once the retail price of her prescription drugs total $4,430 for 2022 for her covered drugs, then she is in the famous Donut Hole, or coverage gap, for her Medicare Part D plan.
She must pay $7,050 retail price to get out of the Donut Hole. She will pay 25% for a brand name drug. The brand name drug manufacturer will pay 70% of that covered drug. And, the remaining 5% will be paid by the prescription drug plan which she enrolled in.
What happens if your brand name drug is not a covered brand name drug on your specific Part D plan? You will have to pay 100% of that cost.
Generics cost less, and for 2022, the cost is a 25% co-pay when in the Donut hole. Unfortunately, many brand name drugs do not have a generic alternative to use.
That is why it is important when choosing a Medicare Part D prescription drug plan, whether enrolling in Medicare for the first time or during Fall’s Medicare’s Annual Enrollment, to be sure all prescriptions are covered on your Medicare Part D plan.
Do research prior to enrolling in a Part D plan because if you choose the wrong plan, you cannot change it until Medicare’s Annual Enrollment Period, which is from October 15th to December 7th every year.
January 1 of each year, the process starts all over again with a new Medicare Prescription Drug plan and different costs, deductibles, and a new Donut Hole.
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Originally published September 30, 2022