Tips for Seniors in the Medicare Prescription Drug Coverage Gap

(NAPSI) – Some seniors who use Medicare to pay for their prescription drugs may encounter the coverage gap, or the "donut hole." After a certain amount ($2,400 in 2007), Medicare temporarily stops paying for prescriptions, and you must pay for your medicines out-of-pocket. Medicare resumes paying for prescriptions after you reach the out-of-pocket limit ($3,850 in 2007). These amounts include both what you spend and what your plan contributes toward your medicines.

Take Action

Check with your health care provider to see if there are other lower-cost medicines that will work for you. Save all your receipts for prescription medicines. Make sure to read and save all monthly statements from your plan. Keep an expense log to track your monthly costs. A sample log is included in the brochure. Never stop taking your medicines as prescribed during the coverage gap. If you have high total costs and don't have extra help during the coverage gap, you can consider switching during open enrollment season (November 15 to December 31, 2007) to a plan that doesn't have a coverage gap.

Most seniors won't have to think about the coverage gap, since it is likely to affect only about eight percent of Medicare beneficiaries. But if you are affected by it, you can take steps to prepare. A brochure available through Your Pharmacy Benefit (YPB), an effort to educate consumers about their prescription drug coverage, can help you understand and manage the coverage gap.

"This brochure describes ways to make sure you don't get stuck in the coverage gap longer than you need to be," said Pat Adams, vice president of external affairs at the National Pharmaceutical Council, one of the organizations involved in YPB. "It also directs people to resources that may help them get extra help during the prescription coverage gap."

The brochure offers specific tips, such as the following: