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Wisconsin Medicare Insurance

Wisconsin Medicare Part D - Avoiding the "Donut Hole" Coverage Gap

Fortunately, there are ways to limit your potential exposure to the coverage gap and lower your overall out-of-pocket expenses.

Ask your physician about generic drug equivalents – In some cases, using generics can lower your out-of-pocket drug costs. Consult your doctor about effectiveness and possible side effects between the name-brand medications you’ve been prescribed and their generic equivalents.

Discuss your finances with your doctor – Many patients are reluctant to talk to their doctors about their finances, so a doctor might not even think about whether a patient can afford a medication prescribed. Based on your medical records, your doctor knows which medications you are taking but perhaps not your out-of-pocket costs or how your plan covers them. You can contact the Social Security Office or your insurance agent for information on financial assistance. Many drug companies also offer assistance programs. Your doctor or his staff may know of other resources for financial assistance.

Consider a State Pharmaceutical Assistance Program – The State of Wisconsin offers the SeniorCare Prescription Drug Assistance Program for U.S. citizens who are Wisconsin residents over age 65. This is an income related program. There is an annual enrollment fee of $30 and copays for the drugs purchased. Not all drugs are covered on the plan; be sure to check with SeniorCare to be sure yours are covered. There are 4 coverage levels, Level 1, 2A, 2B and 3. A deductible may be applied if you are in a higher income bracket. There is also a "spend down" in Level 3. This means you will pay for your drugs out-of-pocket until you reach a specified amount.

This plan is also good for those who take no drugs at all. The premium is low and it is Creditable Coverage to avoid the Part D Penalty for having no drug coverage while you are eligible for Part D.

You can have a Part D plan and have SeniorCare at the same time. You can not use both while in the initial coverage limit of $2,960 for 2015, but it is helpful if you go into the donut hole. Any drug that you purchase will not apply to your out-of-pocket expenses on your Part D Plan. For more information, visit http://www.dhs.wisconsin.gov/seniorCare/index.htm.

Medicare has recognized the increasing burden that Medicare participants are facing to pay for their drugs. Beginning January 1, 2011, in the coverage gap, there was a 7% reduction in the price of generics, and a 50% reduction in the price of Brand Name drugs. This discount will increase until 2020. For 2015, you will pay 65% for generics in the donut hole and 45% for Name Brand Drugs.

If you get through the Coverage Gap - the "Donut Hole" - the costs that you pay are minimal. The plan will pay 95% and you will pay 5% of your drug costs.

Our licensed Medicare Part D specialists can help you find the plan to minimize your drug costs. Contact us today to find out the savings available to you.

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