How can I avoid the Medicare donut hole?

On Behalf of | Nov 2, 2021 | Medicare

The purpose of Medicare Part D is to pay for prescription drugs. Once Part D expenses reach a certain limit, you may find yourself in the “donut hole”.

According to Healthline, the Medicare donut hole increases your out-of-pocket prescription costs once you have reached the limit. In 2022, the Medicare limit is $4,430. Once you’ve reached this limit, you must spend $7,050 out-of-pocket to leave the donut hole. Here are a few steps you can take to keep prescription drug costs low.

Switch to generic medications

Generic medications contain the same active ingredients as brand-name drugs. However, they are often much less expensive, so they stop you from going over the limit in a given year. Check with your doctor first to ensure a generic drug will offer the same therapeutic benefit.

Look for assistance programs

There are many state programs that can assist you in purchasing prescription drugs. Many pharmaceutical companies also provide assistance to people in need. Qualifying for assistance usually depends on your income and assets. In general, people with limited incomes can receive financial help to purchase their medications.

Apply for Extra Help

Extra Help is a Medicare program for people facing financial hardships. It can help pay for things like copays, insurance premiums, and deductibles. Much like assistance programs, Extra Help is usually available to people with limited incomes and financial resources.

Choose a drug plan with additional coverage

Some Medicare drug plans offer additional coverage to keep you out of the donut hole. While they typically charge higher premiums, these plans are worthwhile if you take a lot of medications or if the drugs you take are more expensive.

When choosing a Medicare drug plan, be sure to weigh your options carefully. Making a smart selection can help you avoid exorbitant out-of-pocket costs while also ensuring you have access to the medications you need.