For many people, prescription drugs are the most expensive part of health care. Some medications are so expensive that many people stop taking their prescriptions, and their health problems get worse. Thankfully, there are options for prescription help for Medicare beneficiaries.
Apply for LIS
You might be qualified for Extra Help, or Low Income Subsidy (LIS). Extra Help is a Medicare savings program based on income level. If your yearly income and total assets are at or below 150 percent of the federal poverty level, you may qualify for LIS. Some beneficiaries have saved nearly $4,000 per year by enrolling in LIS. If you’re not sure if you’re qualified, speak to your agent! We can help you look over the qualifications and go through the application process.
If you qualify for LIS, you might also qualify for Medicaid. If you’re eligible for both Medicare and Medicaid, you qualify for Dual Special Needs Plans (DSNP), which are a type of Medicare Advantage plan. DSNPs typically provide coverage for doctor appointments, hospital services and prescription medications.
If you have a DSNP, you will also qualify for a Special Enrollment Period (SEP), which allows you to enroll in new plans or make changes to your existing coverage at any time throughout the year, rather than having to wait for certain times.
Change Your Medicare Plan
If you don’t qualify for a SEP, you will have to wait for the Annual Enrollment Period (AEP) to make changes to your coverage or enroll in a new plan. Original Medicare does not provide prescription drug coverage. However, Medicare Part D or certain private insurance policies called Medicare Advantage plans cover medications and provide prescription help for seniors on Medicare.
Private insurance carriers offer Medicare Advantage (MA) plans to pick up where Original Medicare falls short. Along with prescription drugs, some MA plans can provide coverage for vision, dental, transportation and even fitness classes. Talk to your licensed agent to find a plan that fits your budget and lifestyle.
Consider a Plan With Gap Insurance
The donut hole is a limit on what your prescription drug plan will cover, and it applies to all Medicare clients who don’t have Extra Help. The donut hole will be going away in 2020, but for now, here’s a cost breakdown for 2019:
You will pay for 100 percent of your drug costs until you hit your deductible, which is $415 in 2019. Once you meet your deductible, you will only pay a small percentage of your drug costs until you’ve spent $3,820. At that point, you enter the “donut hole,” in which you will pay up to 25 percent for brand-name drugs and up to 37 percent of generic drugs. The donut hole will end once you spend $5,100 on prescription drugs. At that point, you will only be responsible for five percent of your drug costs for the rest of the year.
Some Medicare plans offer additional coverage to protect you from the donut hole. That’s something you can ask your agent about when you meet to discuss your coverage options!
Request Generic Drugs
Most drugs that your doctor prescribes will have a generic counterpart that works just as well. In fact, the FDA requires that generic drugs have the same level of quality and performance as their brand name counterparts. Brand name drugs are more expensive because the companies that manufacture them had to pay for research and development. They pass those costs onto the consumer.
Ask your doctor if he or she prescribed a name-brand or a generic drug. If your doctor is willing to switch from a brand name to a generic, you might be able to save hundreds of dollars every year!
Let Us Help
Prescription help for seniors on Medicare can come from changing your Medicare Plan, Extra Help or from buying cheaper prescriptions. A highly trained licensed agent with Medicare Plan Finder can help you find a plan that’s right for you. To set up an appointment, call us at 833-438-3676 or contact us here today.
This post was originally published on October 26, 2017, by Anastasia Iliou and was updated on May 23, 2019, by Troy Frink.