Five Ways to Avoid the Medicare Part D Coverage Gap (“Donut Hole”)
If you use one or more prescription medications, you know how important drug coverage through a Medicare Part D Prescription Drug Plan can be. Whether you have a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug Plan, this benefit can help pay for important medications throughout the year. However, at a certain point when you and the plan have spent up to a certain dollar amount, you reach a coverage gap, also called the “donut hole.” This is a temporary limit on what the Medicare Part D Prescription Drug Plan will pay for your prescriptions.
The main way to not hit the coverage gap is to keep your prescription drug costs low so you don’t reach the annual coverage gap threshold. And even if you do reach the gap, lower drug costs and forms of assistance may help you pay for prescriptions you still need, even if they aren’t covered at the time. Here are some ideas:
1. Buy generic prescriptions.
Many common brand-name medications have generic alternatives available, and they are often less expensive. Generic drugs are required by the Food and Drug Administration to have the same ingredients as the brand-name version, at the same dosage, be administered the same way, and be proven to have the same effect. Ask your doctor or health-care provider if any of your prescriptions can be switched to generics.
2. Order your medications by mail and in advance.
Many Medicare Part D Prescription Drug Plans offer medications at a discount if you order a three-month supply by mail instead of picking up a 30-day supply at the pharmacy. Sometimes, a local pharmacy can even offer a 90-day supply of your prescription at the same price as the mail-order plan. It’s worth looking into the different options and comparing the per-pill cost of the bulk options. Some drugs can’t be prescribed in larger supplies, but for those that can, you may find valuable cost savings.
3. Ask for drug manufacturer’s discounts.
Some pharmaceutical companies offer their products at a discount directly to consumers or through doctor’s offices. This is more common for brand-name and specialty drugs, which can be expensive. Ask your doctor or health-care provider when you get the prescription if any discounts are available or if there is a pharmaceutical assistance program. You can also search online as the drug manufacturer’s website may have more information.
4. Consider Extra Help or state assistance programs.
If you qualify, the Extra Help program (also called the Low-Income Subsidy program) can provide financial assistance with Medicare Part D costs. You must have limited income and assets to qualify, and the specific qualification threshold may change each year. Some states also have assistance programs, and these vary in how you qualify and apply. More details can be found at Medicare.gov’s pharmaceutical assistance program page.
5. Shop around for a new prescription drug plan.
A few Medicare Part D Prescription Drug Plans offer benefits in the coverage gap. Those plans that do provide coverage tend to limit what prescription drugs they cover in the coverage gap. Also, the monthly premiums for these plans are typically higher.
While you may not hit the coverage gap, if you do, you may want to plan ahead. Start by getting information on the Medicare Part D Prescription Drug Plans available in your service area. You can do so by entering your zip code into the plan finder tool on this page.