Avoiding the Medicare Part D Donut HoleIn any one year, the Medicare Part D drug benefit provides initial coverage up to a certain level. But then, in most cases, there’s a gap in coverage when you pay 100 percent of your costs before coverage kicks in again. Once your total drug costs (what your plan has paid plus your deductible and co-pays) exceed $2,830 (in 2010), Medicare will cover no more in the year until you’ve spent $4,550. If you reach this limit, catastrophic drug coverage kicks in automatically and your plan will pay 95 percent of your remaining costs until the end of the year. What this means, of course, is that many seniors will reach this “doughnut hole” before the end of the year and will have to pay full price for their medications until they are out of pocket up to $1,720 and catastrophic drug coverage kicks in. In 2009, over 3.5 million seniors reached the doughnut hole. It is not difficult for even a relatively healthy senior citizen to exceed $2,830 in prescription medications. For example, let’s say that you go for an annual check-up and your doctor tells you that your recent lab tests indicate that like a majority of people over 60 years old, you have marginally high blood pressure and your cholesterol is increasing. He or she might recommend that you start taking Diovan to control blood pressure and Lipitor to lower your cholesterol level. (These are the two most popular drugs for blood pressure and cholesterol.) Diovan costs somewhere between $1,600 and $800 per year depending on dosage and your particular insurance plan. Lipitor costs around $1,300 per year regardless of dosage. These two drugs alone can get you into the doughnut hole. If you then add any other health problems such as arthritis, diabetes, sleeping disorders, etc., it is very easy to exceed the $2,830 limit. One very effective way to avoid hitting the doughnut hole is to split pills and tablets in half or quarters whenever possible. Although this would seem to be an obvious solution, many seniors are unaware of that option; or, they have tried a cheap plastic pill cutter and found it didn’t work or was too difficult to use. If you have a family member or know a senior citizen who is likely to confront the doughnut hole situation, please consider talking with them about their medications and help them determine if their pills can be easily and accurately split with a precision pill cutter. In addition, there are undoubtedly numerous nursing homes and assisted living facilities that could save their members thousands of dollars by making precision pill cutters available. Please let me know what you think. Ken Welch |