High Prescription Costs with Medicare: 3 Ways to Avoid The Donut Hole

For those of you with 1-2 expensive brand name medications, it’s easy to feel pain at the pharmacy during the latter part of the year.

For 2015, the Medicare Part D coverage gap (AKA Donut Hole) starts when the total retail price of your prescription costs reaches $2960.  After that amount, you’ll be responsible for roughly 45% the cost of brand name medications and 65% the cost of generics.   

This means that if you have a $200 brand name prescription, you’ll be paying $90 at the pharmacy instead of your usual co-pay.

Luckily for some individuals, there are other options to get prescriptions at lower costs.

Union/Employer retirement plans

Some unions/employers provide retirement prescription plans that do not have a donut hole and can have lower co-pays than certain Part D prescription plans.  If you retired from a union or a company that offers retirement healthcare benefits, check with the benefits office to see if this option is available to you.

Veteran’s Benefits

Veterans may be eligible to fill prescriptions through the VA health system.  Although this can limit you to the VA pharmacy and mail order program, it can amount to significant savings.  To learn more, call your local VA benefits office and arrange a sit down with a benefits specialist.

State Assistance

Individuals with low income can qualify for pharmaceutical assistance programs from the state as well as Medicaid if income and assets fall under a specific level. To see if you’re eligible, check with your state’s department of Health and Human Services or visit a local senior center and speak with a State Health Insurance Program (SHIP) volunteer. 


Johnny Luo M.D.Comment