How to Get the Most Out of Your Part D Benefits

By December 3, 2012 January 3rd, 2020 Making the Most of your Medicare

All Medicare Part D plans have the “coverage gap” or “donut hole” in them.  This is a set amount of money ($2,970 for 2012) available for rx costs until you reach the beginning of the “gap.”  To maximize this amount, you would like to get as close as possible to the $2,970 without going over. (It’s important to note that the $2,970 is the total cost of the drug, not what you have paid.  For example, if your co pay is $10 at the pharmacy but the total cost is $100, $100 counts towards your $2,970 not just the $10 you paid!)

So how do you do this?

The best way to maximize your drug costs would be to call you current Part D carrier (use the member services number on the back of the ID card) and get to a representative.  You could then ask the person how much you have used towards your “gap” as of today and they should give you an approximate amount.  Let’s pretend that you have used $2,500 of your $2,970 leaving you$470 left for the year.  Even if you have enough prescriptions to last until 2013, you don’t want to leave the $470 on the table (because you don’t know what will happen next year!)  If you can order new maintenance meds in 2012, even though you wouldn’t take the prescriptions until 2013, this will let you get the most bang for your buck on your drug plan in 2012.  In a perfect world, you would be able to order exactly $470 worth of drugs and that’s it.  The secret here is to NOT GO OVER THE AMOUNT as that would cause you to have higher costs until 2013.

Now lets pretend that you are already in the coverage gap, which means the price you pay on drugs is higher, and you are in need of a refill.  Instead of ordering a full 3 month supply (which would run you into 2013) you could simply order a 30 day supply to tide you over until 2013.  The donut hole looks at the actual cost of your drugs and a 30 day supply is less than a 90 day supply.  At that time, your costs reset back down to $0 and you can resume buying 90 days supplies again at the lower cost for next year.  You can also investigate buying your generic drugs at pharmacies on their $4 lists.  When you use a $4 list, the prescriptions is not run through your insurance rather it is a “loss leader” used by the store to get you in there.  If you use the $4 list don’t go buying $100 worth of gravy and you will come out ahead!  Here is a link to some of the common pharmacy’s lists:  WalmartTargetSchnucks

I just received news that the new Medicare Part B premium will be $104.90/month for 2013*.  This is an increase of $5/month from 2012. You will automatically be charged this higher amount out of your social security check starting in January.  This should put to bed the rumor that Medicare Part B premiums will be skyrocketing in the next few years.  As I wrote about earlier, the Medicare Part B premium is tied to your cost of living social security adjustment and the Medicare Part B deductible.  The Part B deductible will increase $7/year to $147/year.

*Part B Premiums have since changed

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