Re: The Medicare Doughnut Hole

[Guest guest]

Hi Mark,

 

I suggest the following:

 

#1 - Go to www.medicare.gov to find the prescription plan that's best for you. 

Here's a link to a page where you enter the exact medications you are taking

and Medicare will tell you which RX plan provides the best coverage for you,

based on overall cost, i.e. monthly premium plus copay cost:

 

http://www.medicare.gov/MPDPF/Public/Include/DataSection/Questions/DrugCostsOpti\

ons.asp

 

Note:  Some of the AARP plans don't provide any coverage through " the gap " , but

one of the AARP plans covers generics in the gap and that's the Enhanced

plan.  Gretchen mentioned MEDCO.  Some of the MEDCO plans also have NO gap

coverage, so be careful which one you select.  The MEDCO Access plan does cover

generics in the gap.  There are others who do as well.  So figure out which

provides the best overall coverage based on your needs. 

 

#2 - Another option is to select a Medicare Advantage medical plan in your area

that includes RX coverage with benefits through the gap.  Many Medicare

Advantage Medical plans cover generic RXs through the gap, especially HMO plans

like BC/BS of MA and Tufts HMO.  Very few medical plans will cover all

medications in the gap.  Typically, it's generic only coverage or no coverage at

all.  An HMO is most likely to provide richer gap coverage.

 

Note:  Under normal circumstances, you aren't allowed to switch medical or RX

plans mid-year.  You normally have to wait until open enrollment to switch, with

an effective date of 1/1.  However, they do make exceptions for people having

difficulty affording their prescriptions.  You can contact Medicare to request

an exception and mid-year transfer to the Medical and/or RX plan that works best

for you. 

 

#3 - Go to the " Pharmaceutical Assistance Program " on the Medicare site:

 

http://www.medicare.gov/pap/index.asp

 

Enter each of your medications to see if there are special programs for those

drugs.  In many cases, you will find a phone number to call to get assistance

paying for that specific medication.

 

#4 - Review the other options Medicare suggests for 'bridging the gap',

including any available State programs in your area.

 

http://www.medicare.gov/bridging-the-gap.asp

 

#5 - Last, but certainly not least, call Social Security at 800-772-1213 and ask

if you can apply for " extra help paying for prescription drugs " or simply fill

out an application for assistance online at:

 

http://www.socialsecurity.gov/pubs/10108.html

 

I hope that helps.

 

 

[Guest guest]

,

Thank you for your wonderful advice. I will certainly investigate the

possibility of switching out to a different plan. I've also discovered that

Medco might be a wonderful solution for the future as well. This is very kind

of you, and I sincerely appreciate your time and consideration.

Mark

[Guest guest]

Hello Gretchen

Thank you so much for the courtesy of your time and interest in my

mini-disaster. Your feedback is wonderful. I've looked into several of the

items you've mentioned, and will explore others thoroughly.

You are an incredible resource for all of us afflicted with CMT. As a Group

Support Leader for the CMTA, my mission is to inform, educate and provide

resources for all of those afflicted with CMT. One of my resources for

information has always been your forum, and now, living with my own personal

dilemma, I'm able to share this experience and your advice with other members

who might encounter this unfortunate loophole. Thank you again for all that you

contribute.

Sincerely,

Mark P Boxshus