Mid year checkpoint for Part D

As we approach the middle of the year, now is a good time to review your Part D plan.  Even though the Annual Enrollment Period runs from 10/15/13 – 12/07/13, a little maintenance now can provide more money in your pocket later in the year.

Every Medicare Part D plan has the “donut hole” embedded in it.  The donut hole starts when total drug costs exceed $2,970 (2013 figures).   The $2,970 is calculated off of the actual cost of a prescription, not the amount of your co pay.  For example Nexium, an acid reflux prescription, might be a $35/month co pay at a pharmacy.  The actual cost of Nexium is around $150/month.  The amount that counts to the $2,970 is the $150.  This is important to keep in mind because your annual costs can add up much faster than you realize.   Here is a detailed explanation.

What to do now –

Since we are coming up to the middle of the year, a good idea is to find out what your total drug costs are year-to-date.  Part D companies usually send out quarterly statements advising you of your total drug costs which you can check.  This can be done by calling the customer service number on the back of your Part D card and asking the following:

-As of June 1st, what are my total drug expenses?

Once you get your figure, subtract that amount from the $2,970 and that is your remaining balance for the rest of the year.  If you find that you are close to entering the “donut hole”, here are 4 ideas to do now that can help keep you out of the donut hole later on:

1.  Only put your brand name prescription drugs on your Part D Medicare Prescription Drug plan or generics that are not affordable.  Most generics are very affordable and you can pay for those out of your pocket.

2.  See what generics are in a $4 or $5 generic prescription drug programs at Schnucks, Wal-Mart, and Target, etc…  Pay for the generics out of your pocket.  You do not need a Prescription Drug plan to get their discounted price you only need a prescription from your doctor.

3.  Talk to your Doctor about what brand name drugs can be changed to generics.

4.  Get samples from your doctor.  This can keep you from going into the “Donut Hole” or delay your entry by a month or so.


If you find that you are not even close to the middle point of the donut hole, you can sit back, relax, and enjoy a real donut instead!  I prefer the Bear Claw…

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