Meds and the “Donut Hole”

June 16, 2017
 

While you may not be familiar with the phrase “donut hole,” just about everyone in the health care field and patients who use Medicare know that this can spell trouble for people on medication. There is a coverage gap if your drugs cost more than $2,800 per year, which often affects people on diabetes medications.

This is how Medicare medication benefits (Part D) work, according to the blog on Medicare.gov:

You pay for Part D premiums all year.

You pay 100 percent of your drug costs until you reach the $310 deductible amount. After reaching the deductible, you pay 25 percent of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches $2,800.

Once you reach this limit, you have hit the coverage gap referred to as the “donut hole,” and you are now responsible for the full cost of your drugs until the total you have spent reaches the yearly out-of-pocket spending limit of $4,550.

After this yearly spending limit, you are only responsible for a small amount of the cost, usually 5 percent of the cost of your drugs.

This can be very complicated for most Medicare patients – that’s why NorthBay Healthcare will host a free Medicare Health Fair on Sunday, July 16, from 10 a.m. to 4 p.m. at NorthBay Healthcare Administration Center, 4500 Business Center Drive, in Fairfield. The fair is presented by the University of the Pacific Thomas J. Long School of Pharmacy and Health Sciences to help seniors and other beneficiaries navigate Medicare Part D and hopefully lower your medication costs. This event is open to the entire community and appointments are recommended by calling (707) 624-8230.

For more information about the Medicare Health Fair, visit NorthBay.org

For more info on Medicare benefits go to:
WWW.MEDICARE.GOV

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