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Many folks who are turning 65 or getting onto Medicare for the first time find that the overall health coverage they experience as a Medicare beneficiary is more robust, and often less expensive than the health insurance coverage they had prior. But often times people are surprised to learn that they will actually pay MORE for their medications when they are on Medicare.
Medicare drug coverage can be obtained either through a stand alone Part D drug plan, or through a Medicare Advantage Plan that includes Part D drug coverage. Every year, Medicare has a set formulary, or list of drugs that all Medicare Part D drug plans must cover. Aside from that, plans can differ in which medications they include in their particular formulary. Medicare has no “cap” on your out of pocket drug costs, and if you’re taking expensive medications you may fall into the “donut hole” or coverage gap. This means that when you reach a certain spending threshold, you’ll be responsible for a greater portion of the cost of your drugs. If you find that your Medication costs are getting too expensive, there are a few alternatives I like to recommend.
1. Pay cash without using your insurance card, and use coupons for discounts. My favorite website to recommend is goodrx.com — this site will let you know which pharmacies in your areas have the lowest prices for certain medications, and the site provides free coupons for many drugs as well. If you are at a risk for or close to reaching the Medicare “donut hole” this year, sometimes paying cash for some your less expensive generic medications can help you avoid the coverage gap.
2. Apply for Extra Help through the government. Certain Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. This Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help a person must be receiving Medicare, have limited resources and income. In 2018, in order to qualify for extra help your combined savings, investments, must not be worth more than $28,150 if you are married, or $14,100 if you are not currently married or not living with your spouse. Resources like your home and your car don’t count toward this qualifying amount. To apply for extra help, you can go online to ssa.gov, or call social security at 1–800–772–1213.
3. Look into Co-pay cards, or Pharmaceutical assistance programs. Many pharmaceutical companies offer financial assistance programs for the drugs they manufacture. For folks talking expensive specialty medications for chronic conditions, you can often save thousands of dollars on your medications if you qualify. Qualification criteria will vary based on the drug manufacturer. To see if you qualify, visit [ Ссылка ].
Lastly, many folks tend to go on auto pilot when it comes to their stand alone Part D coverage. It is so important to shop your Part D drug plan annually during the Medicare Annual Election Period, which runs every fall from Oct. 15th — Dec. 7th. Each year your Part D Plan benefits can change, the formulary and tiers can change, and it’s important to review your policy annually to maximize your savings.
Please feel free to call with questions at anytime - (888) 465-9728, or email stephanie@abtinsuranceagency.com
