Medicare donut hole
 

My mother in law is on medicare. She is widowed and has a small daycare at her home to try to pay the house payment and utilities. She pays someone to come in part time to help her with the daycare. She struggles, but seems to make it every month. At about this time every year she falls into the donut hole where her medical needs are not covered. I have looked into the programs that help with prescriptions and so far they all say that the patient cannot have any type of health insurance...she does, just not for the last 2 or three months of the year. Has anyone else had experience with this situation? Any suggestions would be greatly appreciated.

I'm really not sure what you mean by insurance because it seems that she has exhausted her drug allowance thru the Medicare Program for this year.

She should receive a check for $250 from Medicare since she has reached the donut-hole.

She may be able to contact the drug companies to see if they can provide some assistance or she might ask her Doctor for samples.

Some states have free drug discount cards for people without insurance.

Next year might be better, she'll pay half the cost of the drug when she falls into the hole.

Ut oh...I have no idea what a donut hole is. I am on medicare and now I fear I will lose insurance. I am having surgery in January...I hope it is covered.

Can you tell me what it is?

Thank you in advance! Everyones help is greatly appreciated!

hello
 

The donut hole is a very unfair thing. It is when you are allowed so much money from medicare and they pay for most of your drugs. When that set abount runs out, you are on your own. Then you must pay out of pocket for all the remaining drugs you will need for the rest of the year. I have been in this situation many times in the last years. I spent thousands....now I have nothing. I did receive from one drug maker my supply for some of the time. my doctor provided samples but charged me if you can believe it. I didn't know what else to do....ginnie

Thankfully the money that you spend on drugs out of pocket while you are in the donut hole as well as your co-pays is tax deductible.

I believe that the reason there is this 'donut hole' is that Part D Medicare (which is only a few years old) was orignally designed to cover basic medication and catastrophic costs. Not a perfect system but like Social Security, Medicare was not designed to nor can it afford to be enough to cover all your living expenses or medical bills.

this is a new low even for doctors

OK...I do not have Part D...I pay for my own prescriptions.

Thank you everyone!!!!!

If my doctor tried to charge me for samples, I would report him to the Medical Association. The doctor does not pay for those samples, and even is often given "incentives" to make them available in his office. This is quite an ethical breach.

I would find a new doc and report this one.



As for Part D and the donut hole, it acts as sort of a delayed deductible, in that medicare pays for your drugs (with you having a co-pay) until you and they have spent a certain sum, around $2800, and then you must pay all costs until you have paid about $,500 out of your own pocket. After that Medicare once again pays for your drugs.

IMO the Part D donut hole is a cruel trick for most seniors who take expensive drugs for memory problems, cholesterol and heart issues. I think it is sad that seniors have to choose between rent, heat, food, and making drug companies rich.

I personally have begun to ration and change my drugs to avoid the donut hole. My most expensive drug is Pentasa, which runs about $750 a month if I take it full strength, putting me in the donut hole before summer begins. I have actually told my gastroenterologist I plan to wean myself off of it, because it is one of those they can't tell if it really helps or not! On top of that, many people with my medical issues do not take it at all and get by quite nicely. It is also one that the drug company keeps "tweaking" the formula on so that they can get the patent renewed, and keep jacking the price up . . . or I could get it in generic form, as it has been around for a long time.

if you read the recommendations of the deficit commission which came out yesterday you havent seen anything yet as far as cuts to social security and medicare also medicaid while cutting corporate taxes 9%. stay informed. contact your elected officials to advocate for your own future well being.

I found this online: http://www.scribd.com/doc/41924284/D...#fullscreen:on

With a new political house in place, I have a feeling we are going to see a lot of cuts. Smaller government, bigger government we just can't agree on which is better. All I know is when they speak of smaller government a lot of programs that help the sick, elderly and indigent seem to get cut. The Social Security administration has it's work cut out, with millions of baby boomers getting ready to enter the retirement world. What to cut and not to cut is going to become a major topic.

I am appauled that the dr would charge you for samples. I agree with lefthanded...report him. I know it is so hard to find a new doc that you like, but this one is not a good one. On top of what you are already dealing with, he wants to charge you for samples? Crazy.
Good luck to you!

I know this is rather lengthy but it explains all about benefits:

http://www.socialsecurity.gov/pubs/10024.html#facts

Who can get Medicare prescription drug coverage (Part D)?

Anyone who has Medicare hospital insurance (Part A) or medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Prescription insurance is optional, and you pay an additional monthly premium for the coverage.


How much will your survivors get?

Your survivors receive a percentage of your basic Social Security benefit—usually in a range from 75 to 100 percent each. However, there is a limit to the amount of money that can be paid each month to a family. The limit varies, but is generally equal to about 150 to 180 percent of your benefit rate.

I have a client who is also a friend on ssdi, she is disabled and under 60 years old, she gets a small co-pay until she reaches $4,000, I think the co-pay is only about $20 a month and then it goes into catastrophic benefits when she has spent $4,000, and then she pays nothing. She gets some very expensive treatments $7,000 a month for 2 shots for 3 months out of the year, plus all her pain medications which comes out to about $900 a month, plus her asthma medications and anxiety pills, they send all her asthma medications through the mail plus they gave her a oxygen machine plus extra tanks. She pays the co-pay for about 5 months and then reaches the catastrophic benefit. She has full work credits. She made good money, but I wouldn't consider her rich or poor. She has children but they are grown. Also she gets both medicare and medicaid. I helped her win her disability claim, but the agency put her on the medical part. She was run over by a car several years ago and will never get better, plus she suffers from Post Traumatic Stress Syndrome. She has the best heath care out of anyone I ever helped. She's moved from state to state and continues to get the same benefits. If you have any questions I can call and ask her. She says she gets A, B,C and D. I don't know about that, sometimes I have to read her information to understand, all I know is she gets a lot.

Unfortunately you can't turn your doctor in for charging for samples, it is a courtesy to receive them. Here is some disturbing information.

The institute recommended that doctors stop giving free drug samples to patients unless the patient was poor and the doctor could continue to provide the medicine to the patient for little or no cost. By contrast, many free drug samples go to patients with insurance coverage or to doctors and their families, the report said.

http://www.nytimes.com/2009/04/29/he...cy/29drug.html

charging for drugs
 

[I didn't know what my doctor was doing was wrong until recently. I was pretty desperate, and picked the lesser of two evils. When I went in the donut hole, he charged $1,500 per year, and he would give me all the medications from his samples for the rest of the year. I did this for two years. I usually went in the donut hole in july, where medicade part D ran out. The cost of those same drugs through walgreens would have been tripple that amount, so I saved some money. He got money for samples. I was dumb and only knew that I really did need my medicines. Now I just feel bad or mad at the situation I was in. The samples didn't include my pain med.I had a correct scrips for that. So each month I paid for that OTP.

pentasa
 

I personally have begun to ration and change my drugs to avoid the donut hole. My most expensive drug is Pentasa, which runs about $750 a month if I take it full strength, putting me in the donut hole before summer begins. I have actually told my gastroenterologist I plan to wean myself off of it, because it is one of those they can't tell if it really helps or not! On top of that, many people with my medical issues do not take it at all and get by quite nicely. It is also one that the drug company keeps "tweaking" the formula on so that they can get the patent renewed, and keep jacking the price up . . . or I could get it in generic form, as it has been around for a long time.[/QUOTE]

I am in the same predicament w/Pentasa. Use Canada from May; however, the drugs get lost or are very much delayed. I want to be able to cut back. Have u been successful in that. The Crohn bloggers say one cannot cut back. My original gastro said I could, but this new guy says, "no". I do not have a severe case and have resisted all other drugs the docs would have me take with great success. I cannot pay $795 a month. If you are still blogging, let me know. Thanks

en