My Part D USA

QUESTION:  I am new to Medicare, how do I maximize my Part D drug plan benefits and get the most savings on my medications?

ANSWER:  I am going to walk you through step-by-step of how to get the most savings out of your drug plan. 

1.  Before you enroll on a Part D drug plan, the very first thing you need to get is a comparison of the Part D plans, based on your individual medications, so that you know what plans cover your drugs and which plan will save you the most in co-pays and premiums.  We can help you with your comparison anytime of the year, if you are just getting on Medicare or have lost your coverage through your retirement program.  After that, you will need to get a comparison once every year during the AEP, or Annual Enrollment Period of November 15 thru December 31st.  This is the time of year that you can change your drug plan, making sure that you continue to have your drugs covered at the lowest prices.  All the drug plans change the drugs they cover on their formulary and the prices they will charge you every year!  Don’t make the mistake of just “keeping what you have”.  Your loyalty will cost you!  YOU NEED TO FIND THE PLAN THAT WILL SAVE YOU THE MOST IN CO-PAY’S AND PREMIUMS ON THE FIRST 2,700 DOLLARS OF YOUR PLANS BENEFIT BEFORE THE “DREADED DONUT HOLE” IN 2009.

2.  January 1st of every year your Part D drug plan benefits start over.  You will have to purchase $2,700 worth of medications before you fall into the “dreaded donut hole” in 2009.  This is not the co-pay costs, but the RETAIL COSTS are used to add up your purchases.  To maximize your benefits you can begin by NOT purchasing as many of your generic drug as possible using your drug plan.  WHY?  Wal-Mart and some other large retailers have a list of over 300 generic drugs that they sell for $4 for a 30-day supply.  If you email me, I will send you this list.  If you don’t like using Wal-Mart for some reason, many chain drug stores are doing this as well.  Check with them and buy them without using your drug plan, don’t give them your drug plan card and tell the pharmacy this is not to be added to your drug plan coverage.

The reason for this is that every prescription you purchase goes toward the “dreaded donut hole”.  If you purchase your generics off your drug plan, you will have more money left in the pot to pay for your expensive medications, thereby keeping you OUT of the “dreaded donut hole” longer!  Also, when your doctor prescribes a NEW drug for you, tell him/her then and there that you need to use the older tried and true meds, instead of the new designer drugs that are so expensive, IF your doctor feels like you will be able to get the same results.  For those of you that love Sally Field (I DO) and the other celebrities that sell designer drugs and you want to help the drug companies pay their huge salaries for their endorsement (I DON’T), please ignore this advice.  HA! Then tell him/her you need to take samples first, to make sure this drug will work for you.  You would not believe how many prescriptions people get each year that go toward their “dreaded donut hole” and they end up NOT EVEN TAKING THEM, BECAUSE THEY DON’T LIKE THE SIDE-EFFECTS, OR THEY SIMPLY DON’T WORK FOR THEM.  This will keep you out of the donut hole longer as well!

3.  The only folks who need to be concerned about what happens when they hit the “dreaded donut hole” are the folks who know they WILL get to the other side and begin the catastrophic coverage of 95%.  Most people don’t fall into the donut hole.  The rest fall in and never reach the other side.  If you fall into either of those categories, you should STOP USING YOUR DRUG PLAN when you reach the donut hole.  You MUST continue to pay your monthly premiums so you won’t have a penalty, but THERE IS NO NEED TO PAY MORE FOR YOUR MEDICATIONS THAN YOU ABSOLUTELY HAVE TO PAY!!  You will need to do a little research at this point and call your pharmacist and other drug stores to see how much your medications will cost using your drug card, and how much they would cost without using it.  Many of the drug plans charge you a higher retail price while you are in the “dreaded donut hole” to make up for loses they incurred while you were on the much cheaper co-pays amounts.  YOU CAN BUY OR ORDER YOUR MEDICATIONS ANYWHERE YOU CAN FIND THEM CHEAPER!!  You can’t afford to be loyal to your drug plan as they are not loyal to you!

4.  If you have serious on-going health problems and know that you take so many medications that you will ACTUALLY fall into the donut hole and make it across to the 95% catastrophic coverage, YOU MUST CONTINUE TO USE YOUR PART D DRUG PLAN CARD SO THAT ALL THE MEDICATIONS YOU PURCHASE GO TOWARD YOUR GETTING OUT OF THE DONUT HOLE. 

Now, please read my other drug savings tips and donut hole advice by clicking on them in the category section on the left side of this page!  I have much more to tell you!

I hope this answered your question, if not, please write to me, Karyn Blake, and I will find an answer for you ASAP.

I have been getting many questions about DISCOUNT DRUG CARDS.  I have written other blogs warning you about some of them and to never pay a fee to recieve a discount.

There are some NEW cards circulating all across the country from reputable organizations that anyone that is paying retail for their medications or in the “donut hole” should definately check out!!

Please call your local United Way office, your local County or City Health Clinics, and also check with many of your local pharmacies.  Some cards will give you a better discount than others.

Just be sure that you never pay a FEE!  If someone asks you to pay for a discount card, you can be sure it is not one that is regulated by a reputable organization.

The discount cards I have had news reports about are located in Austin, Texas; Gastonia, North Carolina and Brevard County, Florida.  These cards are issued by non-profit organizations such as United Way and others.  Check in your local area to see if a discount card is available for you!

QUESTION:

My mother has only a few hundred dollars left before she will go into the donut hole.  Do you know of any other kind of insurance we can get to cover her drugs during this time?  I don’t think she will be able to afford to pay for them when she has to pay full price.  What can I do to help her?

ANSWER:

I have not heard of any kind of insurance product that will cover drugs during the “donut hole”.  It is a shame that your mother may not be able to pay for her medications.  There are several things you can do.

1.  Contact the manufacturer of that particular drug and ask them if they have any “free help” programs.  Many times they do help people with low incomes.

2.  Find out if you qualify for the “extra help” programs through Social Security.  If you qualify, you will not have a donut hole on your Part D Plan.

3.  IF YOU KNOW THAT YOU WILL NOT REACH THE OTHER SIDE OF THE DONUT HOLE TO THE 95% COVERAGE, YOU MUST BEGIN TO COMPARE PRICES.  YOU NEED TO SHOP ANYWHERE YOU CAN TO GET YOUR MEDICATIONS AT A LOWER PRICE.  DO NOT USE YOUR DRUG PLAN CARD!  YOU WILL STILL HAVE TO PAY YOUR PREMIUMS TO YOUR DRUG PLAN, BUT CERTAINLY YOU CAN FIND BETTER PRICES FOR YOUR DRUGS!

4.  Next year, at the beginning of your plan for 2009, try to buy all your generics and lower priced medication at large retailers that have $4 generics.  This will leave more in the pot to pay for your very expensive medications, thereby extending the time it takes you to reach the dreaded “donut hole”.

If any of my readers knows of an insurance plan to cover the “donut hole”, please CONTACT ME ASAP, so we can check it out.

Until then, we must make the most of our drug plans and save as much as possible!

For those of you who have hit the dreaded “DONUT HOLE” or the coverage gap that is built in to the Medicare Part D drug benefit, watch the prices of your generics!  Many plans inflate prices for generic drugs during that time.  Some of these prices are far higher than widely available retail prices.

When you first join your drug plan you are paying the lower co-pay amounts, but when you fall into the “donut hole” and still present your drug card to the pharmacy, the drug plan still regulates the prices you pay. 

IF YOU HAVE BEEN READING MY OTHER BLOGS ABOUT DONUT HOLE SAVING HINTS, I HAVE TOLD YOU TO STOP USING YOUR DRUG CARD DURING THE DONUT HOLE IF YOU ARE VERY SURE YOU WILL NOT REACH THE OTHER SIDE TO THE 95% BENEFIT. 

How do you know if you are a victim of this scam?

1.  If the price indicated by your plan, as listed on the Medicare website, for a common generic drug is 2 to 3 times the prices charged by other Part D plans, you may be a redneck….I mean victim.  Just checking to see if you are listening!!! 

2.  If the drug prices on your monthly statement for drugs purchased at the phamacy are much higher than the retial price available from your neighborhood pharmacy, you may be a victim.

3.  If your montly statement shows mail-order prices (not co-payments) that are higher than the price charged at your neighborhood pharmacy, you may be a victim.

Please look at your statement!  Call a pharmacy that you do not use and ask them for their price on your generic medication.  If you are paying more than that……..you CAN BUY YOUR DRUGS WHERE YOU FIND THEM CHEAPER WITHOUT USING YOUR DRUG PLAN!!!!!  Check around, shop everywhere!

You will still be required to pay your montly premium to your drug plan, but there is no need to pay higher prices for your medications!!

Congress is working on cracking down on this practice, but it won’t be implemented until 2010.  In the meantime, don’t be fooled into paying higher prices.

At My Part D USA we hope to educate you on the many ways you can save more money on prescriptions!

As we have mentioned before, there will be no National Drug Plan available in 2008 that will cover brand name drugs during the dreaded “donut hole”!

However, there will be plans that cover GENERICS during the “donut hole”.

You must pay attention to how the drug plan intends to cover them, because the quality of coverage will be different on each plan.

The are using the terms….

ALL GENERICS - all generics on their formulary

SOME GENERICS - they have a list of generics they will cover

PREFERRED GENERICS - they have a list of preferred generics they would have you use before covering any others

Before you enroll on a plan that covers generics during the “donut hole” you need to check and see if your medications are on the list. The premiums on these plans are higher, so before you select one, make sure you can actually get your prescriptions on that plan.

When you go to our webiste, on the comparison page, we will have a box named MORE INFO, you can click on this box to see if your drugs will be covered during the “donut hole” on that particular plan you have selected.

Please don’t just assume that your medications will be covered if the plan says they will cover generics during the “donut hole”.

It has been annouced that there are NO plans available for the 2008 coverage year that will include brands during the “donut hole”. We have recieved many calls asking what plan will give more help next year. Unfortunately, there will not be a national plan available.

Last year we had Sierra RX, but they took themselves off the marketplace for 2008. The first year Humana had a plan with brands covered during the donut hole with a premium around $85. Last year many people did not get a comparison and did not realize that Humana has discontinued that coverage and were stuck paying a higher premiun with only generics being covered in the “donut hole”.

That is why we strongly advise you to get a comparison each and every year so that you will not be suprised when your plan changes.

Begining November 15 to December 31st you can go to www.MyPartDusa.com and get a live comparison and also enroll in the plan you choose to be best for you. Enrolling has never been easier! If you need to speak to a personal consultant with any questions or help to navigate the site, please call toll free 866-752-1795.

Remember the LIVE COMPARISONS WILL ONLY BE ACTIVE NOVEMBER 15TH TO DECEMBER 31ST 2007.

We have been receiving so many calls from people that are in the dreaded “donut hole” and need help to pay for their prescriptions. There are no national plans that pay for brands during the “donut hole”, so when you fall into it there is very little you can do. I have a few suggestions:

1. When you begin your plan for 2008, buy all the generics you can OFF YOUR DRUG CARD. There are many large retailers that sell generics for $4. That way all those charges don’t count toward your donut hole, leaving more in the pot to pay for your brands. Only use your drug card to pay for brands and the generics that are too pricey to pay for them off your plan. This will extend the time it takes you to fall into the dreaded “donut hole”.

2. Use generics whenever possible.

3. IF YOU KNOW WITH A CAPITAL K-N-O-W that you will not reach the catistrophic coverage of 95% and you will fall in the “donut hole” never to reach the other side, YOU MUST SHOP AROUND AND COMPARE PRICING AT DIFFERENT STORES, ONLINE, EVERYWHERE. You do not have to continue to buy your drugs using your drug plan card. If you will reach the 95% coverage you must continue to use your card so you will get credit for all your purchases!!!

4. Try going to the Drug Manufactures themselves and asking if you qualify to recieve your drugs for free. They do give out free medications to those who have income too high to receive the Part D Drug Assistance Program from Social Security, but still low enough to need help. You will have many hoops to jump through but it may help. They will require statements from your Part D Plan to prove you are in the donut hole and income records to prove you need the assistance. You can find these companies online.

5. Call us to see if you qualify for any of the “extra help” programs. If you do you will not have a “donut hole” at all!

Toll-Free 866-752-1795