Dunk Your Prescription Costs to Avoid the Donut Hole

Donut hole: This pleasant-sounding name actually describes a coverage gap in Medicare Part D. The donut hole appears when your non-generic prescription costs exceed your plan’s initial coverage limit ($3,820 in 2019), but have not yet reached the catastrophic coverage level. You can avoid the donut hole longer and perhaps entirely by reducing your prescription costs. Here’s how.

Before each year’s end, determine whether you have enough of each medication. If you do, don’t fill those prescriptions until January 1. If you don’t, ask for a smaller quantity for less cost to get you through to year end. Your doctor may have samples as well to carry you over.

During open enrollment, look for a plan that covers your prescriptions for less. Always ask your doctor to prescribe generic drugs if possible. Changes to the donut hole in 2019 mean it affects only non-generic drugs.

To reduce costs, look for pharmacies offering discounts or rewards programs. Ask your pharmacist for a “Medication Therapy Management consultation.” All Medicare Part D plans cover this option. Ask for your prescription’s “best price,” which is the price when you don’t use insurance. However, before buying, call your insurance company and ensure it will reimburse you for “best price” drugs and count their cost toward your out-of-pocket costs. Price shopping can also save you money. Ask your insurance company to recommend pharmacies that offer lower costs, offer 90-day fills rather than 30, or deliver by mail.

Additionally, you can avoid the donut hole if you qualify for Medicare’s Extra Help/Part D Low-Income Subsidy. Visit Medicare.gov for more information.