You automatically qualify, and can sign up, for Medicare Part A (hospital) and Part B (medical) at no cost to you once you reach the age of 65. You still, however, must pay for your own prescription drug coverage. Medicare Part D is a prescription drug plan that you can purchase annually when you start receiving Medicare to help cover the costs of your prescription medications.
The Coverage Gap, previously referred to as the “donut hole,” is when you and your plan have paid a pre-determined amount toward your prescription drug costs in one coverage year. In 2022, that amount is $4,430. Let’s say you pay your usual $20 copay for your monthly prescriptions until you reach the limit of $4,430. Once this amount has been reached, you’re in the Coverage Gap and must begin paying 25% of the full cost of your medication. So, if a prescription’s total cost were $400, you would have to pay $100 (25% of $400).
While Coverage Gap prices have gotten lower, the Gap itself is not going away. But there is help available. Most pharmaceutical companies offer a Patient Assistance Program (PAP) for higher-cost medications once a customer reaches the Coverage Gap. There are different qualifications depending on the medication and pharmaceutical company. SenioRx is a FREE statewide program, locally administered by United Way’s Area Agency on Aging, with advocates who can help you apply and see if you meet the qualifications to receive your medication for FREE or at a reduced cost for the remainder of the calendar year.
Call 1-800-AGE-LINE to find out if the SenioRx program can help with the cost of your medication – and get you through the Medicare Part D Coverage Gap. You can also visit uwaaa.org/seniorx for more information.