The Doughnut Hole project guide is designed for you to help others find out if they are at risk of falling into the Medicare Part D coverage gap and therefore, paying much of the cost of their prescription drugs. The tool generates options for people to discuss with their doctor to avoid unnecessary expense. Your involvement will make a difference.
Medicare Part D, which helps seniors pay for prescription medications, limits prescription drug assistance when an individual’s yearly drug costs surpass a certain level ($2,970 in 2013). Medicare Part D assistance starts again when the person’s drug costs reach another amount ($4,750 in 2013). The gap between those two amounts is the “doughnut hole” or coverage gap. In 2013, seniors who are in the coverage gap will get a 50% discount on brand-name prescription drugs and a 21% discount on generic prescription drugs. In 2014, the brand-name discount will remain the same and the generic drug discount will increase to 28%. Someone you know may fall into this coverage gap.
About 3 million people — one fourth of Medicare Part D enrollees who have filled any prescription — fall into the doughnut hole coverage gap each year.
You can use AARP’s Doughnut Hole Calculator to help determine if a friend or loved one is at risk of falling into the doughnut hole and whether he or she can save money on medications. The calculator is a free online tool that does the math while preserving the user’s privacy. The calculator will offer suggestions for reducing their prescription drug costs so they can postpone hitting the gap or even avoid it entirely.
THE BASIC STEPS
Step 1: Gather Your Friend's Information
Privacy note: After you close the calculator, none of the information will be saved, so privacy will be protected.
Write down the following information:
- Your friend’s zip code
- The exact name of their current Medicare Part D plan (many sound similar)
- A list of the prescription medications they are currently taking
Step 2: Start Using the Calculator
Find the calculator online at http://aarp.org/doughnuthole.
When AARP’s Doughnut Hole Calculator appears on-screen, enter your friend’s zip code and select their Medicare Part D plan from the drop-down menu.
Step 3: Enter Your Friend's Drugs
Enter the list of your friend’s medications in the online Medicine Cabinet.
You can recalculate yearly expenses each time you switch to a new medication by adding up the monthly costs under Explanation of Monthly Drug Costs.
Step 4: View the Report
When the drug list is complete, click on Next to view the report. The report will detail if and when your friend could fall into the Part D doughnut hole. When a person hits this gap, he or she is responsible for his or her drug costs, minus the 50% discount on prescription drugs and 21% discount on generic drugs. (The generic drug discount will increase to 28% in 2014.)
Under the bar graph, click on Click Here for a More Detailed Explanation of Monthly Drug Costs.
Review the explanation with your friend. You may wish to print this page for reference.
STEP 5: See Your Options
Even if your friend won't hit the doughnut hole, you can continue to use the tool to look at how he or she can save money on prescription drugs by using a less-costly drug. Simply click on the Any Options to Save Money? link beside the drugs listed in your friend's Medicine Cabinet and then recalculate the costs with the new choice.
Some medications may have no lower-cost alternatives, while others may have up to three lower-cost options. Some of the alternatives are generic drugs; others may be therapeutically similar alternatives.
To switch to a less expensive drug, your friend will need to talk to his or her doctor. Click on Switch Back to the original prescription to print out a letter to the doctor asking him or her to consider lower-cost alternatives.
Even if your friend isn't at risk of hitting the doughnut hole, suggest that he or she consider switching to less expensive drugs to save money – but only if his or her doctor agrees with switching medications.
You must click on Print Letter to Doctor for each medication that your friend might want to switch.
STEP 6: Print the Wallet-Sized List
Regardless of whether your friend finds possible cost savings, be sure to print the wallet-sized list of the drugs your friend is taking – and a few extra copies, for example, to give to his or her family members or stick on the refrigerator door.
Be sure to print the letters and wallet cards and take notes if you need to. The calculator will not save any information you enter! This is to ensure that every user's privacy is protected.
STEP 7: Inspire Others on CreateTheGood.org!
KEEP UP THE GOOD!
Visit www.CreateTheGood.org for a range of opportunities to use your life experience, skills and passions to benefit your community.
Learn more about how the Doughnut Hole is closing - www.aarp.org/health/medicare-insurance/info-01-2011/ask_ms_medicare_question_92.html
Learn more about Medicare Part D - www.aarp.org/health/medicare-insurance/medicare_partD_guide/
Use this Medicare Glossary to define words, phrases and jargon - www.aarp.org/health/medicare-insurance/info-11-2009/Medicare_partD_guide_glossery.html
Avoid the gap altogether if you’re eligible for the Medicare Extra Help Program. Find out if you qualify by going to Benefits Quicklink - www.aarp.org/quicklink
Find information on drug interactions, side effects and more - http://healthtools.aarp.org/drug-directory
Learn more about how to save on presription drugs - www.aarp.org/drugsavings
For free brochures send an email to firstname.lastname@example.org with the following information: publication title, publication stock number, quantity requested, your name, your address, date desired, your phone number.
- Request Stock# C2525 for “Don’t Dump Dollars into the Doughnut Hole!” Or, request Stock# D19215 for “¿Sabe lo que es el “doughnut hole?” en español.
- Request Stock# D29506 for “Savings You’ll See in Medicare Part D.” Or, request Stock# D19507 for “Nuevos ahorros con Medicare Parte D?” en español.