
11/13/2024
You enter the "Medicare donut hole" when what you and your plan paid for your total medication costs reaches a certain limit. In 2024, that limit is $5,030.
While in the coverage gap "donut hole," you are responsible for a percentage of the cost of your drugs.
It’s a significant percentage.
You are out of the donut hole and enter catastrophic coverage once you've spent a predetermined amount out of pocket for covered drugs. In 2024, this amount is $8,000.
Read that again: $8,000 out of pocket, before some costs are offset again.
Once you're in the catastrophic coverage phase (you've reached $8,000 out of pocket), you'll pay a low copayment or coinsurance for prescription drugs.
If, you can afford to pay the costs until you reach $8,000 out of pocket.
Let's talk about Eliquis. The list price for a 30-day supply of Eliquis is $594. The cost at our pharmacy is: $622.50 - with GoodRx discount card.
I depend on Eliquis, since my diagnosis of unprovoked pulmonary emboli 2 years ago.
What you pay when using GoodRx does not count towards your deductible or getting out of the donut hole.
Starting in 2025, the donut hole is gone.
Instead, all Medicare plans will have a $2,000 out-of-pocket spending cap for covered prescription drugs. Once you reach that amount, you'll automatically get catastrophic coverage.
What about November and December of 2024? The last 2 months of the year.
Many people reached their "donut hole" last August. They depended on samples, or they bought Eliquis in Canada or Mexico for $89 month supply.
Some ration their medications and decrease their dosage to make their prescription last longer, putting themselves at risk for clots.
It's like this: 1 in 7 elderly people cannot afford their medications.
That jeopardizes their health, and can be life threatening.
Yesterday, two of the largest cardiology practices in the valley, had NO Eliquis samples left, at any of their sites. They gave out all of their samples to patients in the "donut hole" over the past few months.
What about November and December of 2024?