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So I am on disability and I know I will qualify for medicare after being on it for two years. But what is this doughnut hole talk that people are talking about? I have heard this term over and over again when it comes talk to medicare and something about staying out of the doughnut hole but I am just confused to what exactly it is. Sorry if it seems like a stuipid question I just thought I would ask.
If you as a single person only make $12,500 a year or as a married couple $25,000 a year, you will qualify through Social Security for the "low income asst program" for your meds through a Medicare Part D program and won't have to pay very much and may never go into the "donut hole or gap".
However if you earn more be it single or married than the above amount, you could fall into this "donut hole or gap in coverage" of the Medicare Part D drug RX plan after you AND the Part D plan has paid $2,850. After that, you would still get most generic meds at the cheaper rate however if you are on any expensive brand name meds of any kind, you could pay close to full price and then only the part you pay is counted until you reach $4650 (they may have raised it this year but less than $5,000).
At that time the Medicare Part D plan will pay most of all of your cost and the brand name med can only cost you no more than 15% or less. The generics would be cheaper on most Part D plans but even those are all so different.
When you get Medicare A/B, the government may assign a Part D plan for you this year. You can only change to another plan for Part D from November 15th through December 31st of each year.
An example is I am single and earn more than the amount to get the low income asst which can be filed online through Social Security.
Because of that each year in May I will fall into the Part D "donut hole or gap coverage". My $40 brand name script goes up to close to full cost; about $580 a month and the rest of my generic scripts are $8.
If I did qualify for low income asst, I would never pay more than $6 all year for any brand name and some meds are $2-3 or no charge all year.
This isn't a stupid question at all and I of all people hate to know this much about it. I make annuities on top of my SSDI which is what makes me go over the $12,500 a year as a single person and almost financially ruins me every year. It's horrible.
Supposedly there may be a chance this year that CMA might give a 50% discount on any brand name drugs during the "donut hole" but that hasn't been set in stone yet.
Also the "donut hole" is supposed to close under Obama's Health Care plan in 2014.
I hope this helps you understand so you can make good decisions. Apply for the low income asst if you qualify before you get your Medicare if you know it's on it's way or speak to someone at your local Social Security office or online.
It may have been changed to $4850?
If anyone knows, please list it.
Thanks
That was a great explanation, I am always confuse with the darn donut hole! Lovebaby, here's the Medicare website, were you can ask question and get the answers that you need, I hope it helps.
http://www.q1medicare.com/q1group/FAQ.php?category_id=118&parent_id=118
Very, very excellent question too
Thaks ladies for the great information.