Senior citizens enrolled in Medicare often find themselves at risk of falling into the “donut hole.” How can you avoid taking the plunge?
In America, if you work hard and play fair, the government repays you by covering your healthcare costs after you turn 65. If you’re a legal citizen who pays into the social security system for a minimum of ten years, you’ll become eligible for Medicare, a federally funded insurance program.
Medicare is especially useful for retired senior citizens who no longer receive insurance through their jobs.
Unfortunately, many people who enroll in the program face a variety of unexpected and unwelcome issues. One of the biggest problems is the risk of falling into the Medicare donut hole, also known as the coverage gap.
The donut hole forms when a Medicare plan places a cap on what the government is willing to cover when it comes to medication, leaving the patient with no medicine and the very frightening prospect of a large bill.
How Does the Donut Hole Work?
The donut hole won’t affect everyone — those at risk of getting shorted by the coverage gap are mainly Medicare members with a Part D Plan, coverage built specifically to cover individual prescription drug needs.
To explain further, they can expect to run into a coverage gap after spending a significant amount of their plan on covered prescription drugs. Above and beyond this total, the member is responsible for a higher percentage of out-of-pocket drug costs.
Let’s say, for example, you just enrolled in your Medicare Part D plan. At the onset, you pay 100% of all drug costs until you fulfill your $310 deductible. Then, you’re responsible for a 25% coinsurance [link to coinsurance blog] on the total cost of your prescriptions, and your Part D plan covers the rest.
However, once both the costs you pay out-of-pocket and those covered by your plan reach a combined total of $2,960 on covered drugs, you enter the donut hole. You will now be responsible for 45% of covered drug costs until you hit your yearly out-of-pocket spending limit of $4,700.
In this scenario, it’s easy to see how the donut hole can quickly throw many Medicare subscribers into serious financial turmoil. And no senior citizen should have to make the choice between food, rent, and prescription drugs.
How Can I Avoid the Coverage Gap?
There are a number of ways for Medicare Part D members to avoid falling into the donut hole. One option is to apply for the Medicare Extra Help program, which is designed to aid those who meet specific income limitations pay for coverage gap prescription drug costs.
But many don’t qualify for Extra Help, and that doesn’t mean they can afford to fall into the donut hole. That’s why it might be time to look at insurance alternatives like SingleCare in order to cut costs and avoid hidden fees.
A SingleCare membership card provides patients with average savings of up to 50% on prescription medications, translating into hundreds of dollars each year. And you’ll never have to worry about uncovered excess fees, because with SingleCare, what you see is what you pay.
(Main image credit: Images Money/flickr)