MediCare "Donut hole"?

I get my meds from overseas. Don't have to worry about the donut hole. I can buy a 12 months' supply of three meds for what the co-pay for two months of one med would cost here in the states. I do have part D, though, for spur of the moment meds like an antibiotic or prednisone. They do not sell narcotics and other types of "controlled" meds.

Coverage in the "GAP" or donut hole seems to have changed this year and will continue to change. Get confused here:
Donut Hole charges

bsinmich wrote:
All you need to be considered insured under Medicare is any Part D so you can change if you want in the future. I sell Medicare Supplements but only in Michigan. My main company charges about $65 per month for Part D. I recommend my people to go to Wal-Mart for their part D for less than $20 per month. Rates will vary by state and even region in a state so they not be true in your state.

Some of the stuff my wife takes she can't even get at Walmart. We switched to a small local chain of pharmacies. Very personal service. The only downside is somewhat reduced hours.

All you need to be considered insured under Medicare is any Part D so you can change if you want in the future. I sell Medicare Supplements but only in Michigan. My main company charges about $65 per month for Part D. I recommend my people to go to Wal-Mart for their part D for less than $20 per month. Rates will vary by state and even region in a state so they not be true in your state.

I am puzzled. Why on earth is Medicare so darn difficult to figure out? So many options, so many rules are different from one person to another. Here you are in the "golden years" where thinking may be hampered with age and you have to figure out what's what with Medicare. If you goof up, you stand the chance of losing your shirt. It should be much more simple for all of us. Do you think maybe the idea is to hope we lose our shirt?? Just an observation.

Simple in round numbers: Medicare helps to pay 80% of most of your medication up to about $3K. Then you enter the donut hole. You must pay 100% of your medication for the next $3K. After that medicare picks up 100% of most medications.
The are exceptions to every Medicare (government) rule, so you can expect lots of exceptions depending on the medical condition. Dialysis, and some other long term problems have all types of exceptions.
Back to the donut. If you can, always get generic medications. You can also shop these medications for price. If a major chain or a small independent will sell you a medication for $4.00 but you only pay $2 billing medicare, your medicare account is being charged $10. If your doctor suggests a brand drug and your cost is $25 medicare is being charged $125.
When you reach the donut threashold (like $2,500 or so) you will be charge the full cost of the medication until you reach the other side of the hole.
The best plan is to shop prices.

Here is the Medicare website for Part D which is drug coverage and the coverage gap. (donut hole).
Medicare & Part "D"
With the changes in the Affordable Care Act, (ObamaCare)-- charges, coverages and limits are changing, and of course it has always been hard to follow.

bgum wrote:
It will start by paying for some of the cost of meds. Then when you reach a $ limit it will stop paying for meds until you reach another plateau at which time it will start paying for meds again. The area where it doesn't pay is the D hole.

That's a pretty good explanation. We just signed my wife up, she's disabled at 40 years old. We went with SmartD Rx. So far, so good. They offer several different plans with different co-pays, deductibles, etc.

Pretty sure the Medicare website has a tool to plug in your current meds and it will give you the best total cost option. She takes multiple meds so we went with the biggest plan, she pays very little for her refills.

MediGap Insurance is a whole different animal. We went to our local Area Agency on Aging and someone finally explained it in understandable terms. We went with Plan F through Harvard Pilgrim. Fills in every single gap, no co-pays or deductibles. We are anticipating a major neurosurgery. But it's expensive, about $140 month. Between the Medicare deduction from her SS check, the Rx plan, and the MediGap her insurance is $4k per year. But she's basically covered for everything, very little out of pocket.

It will start by paying for some of the cost of meds. Then when you reach a $ limit it will stop paying for meds until you reach another plateau at which time it will start paying for meds again. The area where it doesn't pay is the D hole.