The Medicare Donut Hole Explained

The Medicare Donut Hole Explained

Medication Assistance

What is the Donut Hole?

The coverage gap, commonly called the “Donut Hole” is a temporary limit on what your Medicare Prescription drug plan will pay for your prescription drug costs.

While you are in the “Donut Hole”, you will pay higher costs of for your brand-name drugs. Often times these increased costs make your medications unaffordable.

If this sounds like you or someone you know, call Simplefill Prescription Assistance programs to enroll in their program during this period. 1-877-386-0206

The experts at Simplefill make understanding your Medicare Part D plan…well Simple!

There are 4 stages to your part D plan. Let’s break it down for you.

Stage 1: Deductible Phase
In this stage, you must pay a certain amount out of pocket before your prescription drug plan will kick in. This amount varies by plan.

Stage 2: Initial Coverage Phase
After you hit your deductible, you will start paying the plan’s cost share for covered medications. Once you and your prescription plan have spent $3,310.00 in 2016 for covered drugs; you’ve reached the “Donut Hole”.

Stage 3: The Donut Hole, Coverage Gap Phase
This is the stage where you start getting that sticker shock. Unless you want to wait until January 1st when your plan resets, you will now be paying 50% of the retail price of your medications. This can be very expensive and not an option for most patients, especially ones who are on fixed incomes.
This is why we urge you to contact us at 1-877-386-0206 or apply for assistance online.

Stage 4: Catastrophic Phase
You get a bit of a break in this stage since you have spent so much out of pocket for the year. During the catastrophic stage, you pay whichever amount is greater –either 5% of the covered drug cost or $2.65 for generics and $6.60 for brand name drugs.

What if I am not in the coverage gap but I still cannot afford my medications or my medication is not covered at all?
It never hurts to pick up the phone and ask. Often times we can help patients when their medication is not covered or if they have a copay is unaffordable. We always advise our patients to call us and we can find them the best way to save money on their medications. Think of the team at Simplefill as your Medication Savings Advisors!

Important Fall 2014 Healthcare Open Enrollment Tips and Deadlines

Important Fall 2014 Healthcare Open Enrollment Tips and Deadlines

blog Prescription Assistance

The Open Enrollment period for healthcare under the Affordable Care Act is coming up soon, and we want our Simplefill community to be prepared for this important time of year. Grab a pen and get ready to mark your calendars with the information you need about coverage from a Qualified Health Plan.

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Important Medicare Dates You Need to Know for 2014

Important Medicare Dates You Need to Know for 2014

blog Medication Assistance News

If you have Medicare, get your calendars ready! These important dates will keep you organized and ensure that you enjoy all of your coverage benefits; Simplefill has gathered these dates to keep you prepared:  

January 1

Starting the first day of 2014, your Medicare insurance plan goes into effect. Any changes made by you or Medicate to your plan started on New Year’s Day.

January 1 – February 14

This is the Medicare Advantage Disenrollment Period. During this time you can:

  • ·         Drop your Medicare Advantage Plan
  • ·         Switch to Original Medicare
  • ·         Enroll in a Medicare Cost Plan
  • ·         Add a Medicare prescription drug plan (if you switched to Original Medicare)

October 1-15

Set aside time to compare different Medicare health plans to see which one best meets your needs. Doing research in advance will help you evaluate your alternatives.

October 15 – December 7

This is Medicare’s Annual Enrollment Period. During this period, you can:

  • ·         Change your Medicare health insurance or prescription drug coverage for 2015
  • ·         Join or drop a Medicare Advantage, Medicare Part D, or Medicare Cost plan

If you don’t wish to make any changes to your Medicare coverage, your plan will remain the same in 2015. It isn’t necessary to enroll if you are keeping your plan the same.

January 1 – December 31

People turning 65 can enroll in the Medicare Part D plan for the current year. If you’re a Medicaid recipient, you can make changes or enroll in the Medicare Part D plan for the current year.

Mark these dates on your calendar to take advantage of your Medicare coverage. If you have any questions about your prescription drug services under Medicare, please don’t hesitate to get in touch with our support team.