Tuesday, February 24, 2009

Bridging The Coverage Gap

Most Medicare drug plans (Part D) have a temporary limit on what they will cover for prescription drugs, or a “coverage gap.” The good news is that all Medicare drug plans provide coverage if you have an unexpected illness or injury that results in extremely high drug costs. This is called “catastrophic” coverage. It assures that once you have paid $4,350 (in 2009) out-of-pocket for drug costs in a calendar year, almost all of your drug costs above that amount are covered. If your plan has a coverage gap during the time between a drug plan’s standard level of coverage and the catastrophic coverage, you pay all of your drug costs.

If you have limited income and resources, and qualify for full extra help, most of the information here doesn’t apply to you. You will continue to pay the same copayment or coinsurance amount during a coverage gap if your plan has one.

If your drug plan has a coverage gap, here are some ways you can avoid or delay entering the gap, and continue to save money on drug costs while in the gap:

Consider switching to generic, over-the-counter (OTC), or other lower-cost drugs. Ask your doctor about generic, OTC, or less-expensive brand-name drugs that would work just as well as the ones you’re taking now. Switching to lower-cost drugs may be enough to help you avoid the coverage gap, and can save you hundreds or thousands of dollars a year.

Keep using your Medicare drug plan card, even while in the coverage gap. Using your drug plan card ensures that you’ll get the drug plan’s discounted rates and that the money you spend counts toward your catastrophic coverage.

Explore National and Community-Based Charitable Programs that might offer assistance (such as the National Patient Advocate Foundation or the National Organization for Rare Disorders). These organizations may have programs that can help with your drug costs. Comprehensive information on Federal, state, and private assistance programs in your area is available on the Benefits Checkup Website (www.benefitscheckup.org) website.

Look into Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs) that may be offered by the manufacturers of the drugs you take. Many of the major drug manufacturers are offering assistance programs for people enrolled in a Medicare drug plan. You can find out whether a Pharmaceutical Assistance Program is offered by the manufacturers of the drugs you take by visiting www.medicare.govand selecting “Lower Your Costs During the Coverage Gap.”

Look at State Pharmaceutical Assistance Programs (SPAP) for which you may qualify. There are 23 states and 1 territory offering some type of coverage to help people with Medicare with paying drug plan premiums and/or cost sharing.

You can find out if your state has a State Pharmaceutical Assistance Program by visiting www.medicare.gov and selecting “Lower Your Costs During the Coverage Gap.”

Apply for Extra Help. If you have Medicare and have limited income and resources, you may qualify for extra help paying for your prescription drugs. Contact Social Security by visiting www.socialsecurity.gov or calling 1-800-772-1213.

Warm Regards,

Mark A. Bowman, President
By Baby Boomers…For Baby Boomers
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