Open Enrollment: the Medicare Part D “Donut Hole” Review

With only a week before Medicare Open Enrollment starts, we’ve been getting questions about next year’s changes to the Medicare Part D prescription drug coverage gap.  Most seniors know that healthcare reform has made their prescription drugs more affordable by working on closing the “donut hole,” but they’re not exactly sure how and most importantly right now, they’re not sure how those changes will affect their prescription drug coverage for next year.

We know that paying for prescription drugs is one of the biggest worries for many senior citizens, so here’s MyHealthCafe.com’s “cheat sheet” to paying for prescription drugs in the Medicare Part D “donut hole” for 2012.

Of course, the “donut hole” refers to the coverage gap in the Medicare Part D prescription drug coverage. In 2012, once your total drug costs reach $2,930 (including both your share and your insurer’s share for costs), you will qualify for a discount on your brand name drugs of 50% and a discount on your generic drugs of 7%. Then once your out-of-pocket drug costs hit $4,700 for the year, catastrophic coverage will kick in and cover 95% of your drug costs. (Whee!)

Now note: there is a trick in how you calculate what counts towards the $4,700 for catastrophic coverage. 100% of your brand name drug costs count towards the $4,700 in costs needed to get to catastrophic coverage, but only the 93% of generic drug costs that you pay count. If you are using generic drugs (which you should, because they’re generally cheaper), it may take you a bit longer to get to your catastrophic coverage, but not much longer and the discounts should help a lot.

Have you hit the Medicare Part D “Donut Hole” this year? Tell us about it!

Related posts:

1. Are You in the Medicare Part D “Donut Hole” Yet?
2. Halfway Through the Year! How Far Are You Into the Medicare Part D “Donut Hole”?
3. How Far Are You Into the Medicare Part D Prescription Drug “Donut Hole”?
4. Medicare Part D Open Enrollment: Don’t Forget About These Changes to the Doughnut Hole!
5. The Donut Hole: How Expensive Are Cancer Drugs for Seniors with Medicare?