I've seen many references to people suffering because they are in a doughnut hole created by Medicare. Can anyone shed light on this term to a newbie? In my book, donut holes have always been a positive thing, but the vibe I'm getting does not sound positive.
3 Aug 2012
Its this darn thing someone dreamed up for the insurances to save money. Once they spend out a specific amount, it can vary according to your plan, you have to pay for your meds, until you spend a specific amount, then it will pay again. Its a wonderful part of medicare part d. The new healhcare law is closing it, but not soon enough for those on part d. If you can't afford your med without insurance in the beginning, why can you later? Don't forget when you get in the donut hole, you are still paying for your insurance.
3 Aug 2012
Hey bills4pills - your "vibe" is spot on!!! It isn't a positive thing. Your prescriptions, if they are brand name, will cost you full retail. If you are getting generics, it won't be so bad. Let's say you have the Fentanyl patch for instance. Your co-pay is $42/month. That is considered one of the higher tiers and it will run you around $400 when you hit the donut hole. Lovely, just lovely. It would behoove you to try to get as many of your scripts as generic and have talks with your doctors about the issues and costs of your meds going into the donut hole. They will understand. However, I did have one doctor tell me that I had better come up with the money for the Fentanyl patch because they worked so good. How is that for sensitivity???
Well you know something, if they came from DunkinDonuts that would be a good thing or Bess Eaton but in the world of insurance - not so much.
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