Frequently Asked Questions about Medicare Prescription Drug Coverage

By Ron Pollack Modified: February 28, 2013 at 1:27 pm •  Published: February 28, 2013
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Q. What will I pay in premiums, deductibles, and copayments?

A. Premiums for prescription drug plans vary widely. In 2013, the national average is $30 per month, but there is a big range across geographic areas and for different Medicare Advantage and Part D plans. Deductibles, which refer to how much you must pay out of pocket every year before your plan will kick in, range from $0 to $325 in 2013. Copayments vary from plan to plan.

Q. So what is the “doughnut hole?”

A. The doughnut hole—a feature of Medicare Part D since 2006—is a big gap in drug coverage. Before the Affordable Care Act became law, when you reached an initial limit of total drug expenses ($2,970 in 2013), your drug coverage stopped—meaning you had to cover 100 percent of your drug costs—until you spent $3,764 out of your own pocket.

But there’s good news: Thanks to the Affordable Care Act, the doughnut hole is shrinking. In 2013, you will save 52.5 percent on brand-name drugs and 21 percent on generics at the pharmacy while you are in the doughnut hole. By 2020, the doughnut hole will be completely eliminated.

 Q. What if I can’t afford a Part D plan?

A. You might qualify for the Extra Help program that’s run through Social Security. You can find out more at the Social Security website, www.socialsecurity.gov/prescriptionhelp, or by calling 1-800-MEDICARE. Some states also have their own programs to help people with high drug costs.

Q. Where can I get help choosing a plan?

A. Selecting the right plan can be difficult. Try the Plan Finder at Medicare.gov, or call 1-800-MEDICARE. For personalized assistance, ask for a referral to a counselor at your state’s SHIP program.

 

Families USA is the national organization for health care consumers. We have advocated for universal, affordable, quality health care since 1982. Ron Pollack is the Executive Director of Families USA.