For 2011 you indicate that the full retail cost of drugs while in the donut hole will apply to the amount required to get out for name brands even though I'm only paying 50%. Can you clarify?
Complete Question: For 2011 you indicate that the full retail cost of drugs while in the donut hole will apply to the amount required to get out for name brands even though I'm only paying 50%. I talked directly with Medicare and they said I will still have the same out of pocket requirements, i.e. it'll just essentially take me twice as long. Can you clarify?
The Medicare representative is correct in saying that your requirement (out-of-pocket cost limit or TrOOP) to get out of the coverage gap will not change in 2011. It will remain $4,550. What has changed is the definition of what is counted toward your out-of-pocket costs (so, what counts toward the $4,550).
The out-of-pocket costs include not only what you have paid toward your prescriptions, but also what specific programs have paid toward your medication costs. The Medicare Coverage Gap Discount Program has been added to the list of programs.
The full list of programs that count toward your out-of-pocket costs includes: The "Extra Help" program from Medicare; Medicare's Coverage Gap Discount Program; Indian Health Services; AIDS drug assistance programs; most charities, and most State Pharmaceutical Assistance Programs (SPAPs).
if your medication purchases for 2011 are the same as 2010, you should go through the donut hole in the same amount of time. It will just cost your less.