[misysme]

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.

[carlacanel]

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.

[Cblue]

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!

[ginnie]

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

[Shellback]

Originally Posted by virginia neill

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.

[Kitt]

Originally Posted by Cblue

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!

Part D is what you carry if you are on drugs. The donut hole is there (Part D). Otherwise, you are not going to lose any Medicare coverage you have for like surgery, and the rest of your health issues, etc. It's the drug plan you carry (Part D), if you do in fact carry that plan.

http://healthinsurance.about.com/od/...ing_part_d.htm

[Janke]

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.

[echoes long ago]

Originally Posted by virginia neill

my doctor provided samples but charged me if you can believe it.

this is a new low even for doctors

[Cblue]

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

Thank you everyone!!!!!

[legalmania]

Originally Posted by misysme

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 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.