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Making The Most Out Of Part D Coverage

Armen Hareyan's picture

Part D Coverage

Understanding the true out-of-pocket costs of medications can help millions of patients save on their healthcare spending without sacrificing quality care. As people with Medicare enroll for 2008 Part D prescription coverage, financial and pharmacist experts explain how to stretch this health insurance coverage to make the most of it. Mary Hunt, financial expert and creator and editor of Debt-Proof Living, and Timothy Tucker, pharmacist and Medicare Part D expert, offer ways to plan ahead and avoid overspending while meeting medication needs.

As Medicare Part D goes into its third year, Hunt and Tucker, partnering with Prilosec OTC, aim to help people with Medicare navigate their way through Part D and delay or avoid the phase known as the coverage gap, when members must pay 100 percent of their medication costs out-of-pocket.

"As we have learned, Medicare Part D helps millions gain affordable access to prescriptions, however it can be difficult to understand, and may lead to thousands of dollars lost," said Tucker. "People are often afraid to cut costs on important things such as healthcare, but there are ways to save without sacrificing the quality of the medications. Pharmacists are trained to understand Part D to give patients practical advice on how to manage medications appropriately while making the most of prescription coverage."

Nearly one in five people in Medicare Part D was affected by the coverage gap last year - either they hit the gap or they cut back on needed medication to avoid the gap. A study by Wolters Kluwer Health, a global provider of drug and medical information services, revealed that 16 percent of enrollees chose to discontinue medications rather than switch to generics. Hunt provides information to help members plan ahead, save money in their plans and become educated about Part D to avoid discontinuing medications or falling into the gap.

"People can do more than they think to delay or avoid the coverage gap and manage spending," said Hunt. "Having a conversation with their doctor and pharmacist about their medication options to identify savings is a great first step. It's important to understand what Medicare Part D covers, and save coverage for medications for which there is no alternative - it is possible to save on the essentials."

Hunt offers additional tips such as the following to Medicare Part D members:

-- Control your finances by planning ahead.

-- Ask your insurance company and pharmacist to make sure you know how much you are spending on prescription medications.

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-- Make sure you are choosing the right plan for your prescription needs. Learn about your plan options early in order to effectively manage your spending and save money.

Tucker adds:

-- Review your medications with your doctor and pharmacist to see where you can identify savings, in order to avoid reaching the coverage gap.

-- Talk to your doctor and pharmacist to determine if there are over-the-counter (OTC) medicines available to treat your conditions. For example, if you have a condition such as frequent heartburn (heartburn two or more days a week) you can talk with your doctor and pharmacist about using an OTC medication such as Prilosec OTC.

"OTCs are an excellent money-saving treatment option, since they do not count toward reaching the initial coverage limit," said Tucker. "Utilizing OTCs, some of which are former prescription medications, is a great way to potentially avoid the coverage gap, plan ahead and make the most out of Part D coverage."

About Medicare Part D and the Coverage Gap

The Medicare Part D program provides people with prescription medication coverage. The program began in 2006 and continues to help millions who are 65- years and older or disabled gain affordable access to prescriptions. Medicare Part D works in three phases.

-- In Phase 1, each member typically pays a deductible, and once that is met, pays an average co-pay of 25 percent for prescriptions. The plan pays the remaining balance. But, if expenses reach an initial coverage limit before the end of the year, the member arrives at Phase 2, also called the coverage gap.

-- In the coverage gap, members have to pay 100 percent of medication costs out of their own pocket, unless they have a Part D plan that bridges the gap.

-- Once they spend enough to reach a second limit, the catastrophic coverage, or Phase 3, starts. Phase 3 is when Medicare pays nearly all of prescription costs (95 percent).