Tips to Help in Medicare Coverage Gaps

Access to Benefits Coalition and the National Council on Aging

Tips to help people in the coverage gap

Apply for the Extra Help/Low-Income Subsidy (LIS) if your income is below $14,700 if you’re single (or $19,800 if you’re married and living with your spouse) AND your resources are below $11,500 if you’re single (or $23,000 if you’re married and living with your spouse).

Medicare beneficiaries with limited incomes and resources who qualify for the LIS have no coverage gap. You can find out if you might be eligible for the Extra Help and apply for it at www.BenefitsCheckUp.org or www.SocialSecurity.gov.

• Talk with your doctor about changing to generic drugs wherever possible (especially if you're in a plan that covers generics during the gap). You can also talk with your doctor about switching to a lower-cost brand name drug that also treats your condition (i.e., is in the same therapeutic class).
• See if you can get free samples of the medications you take from your doctor(s).
• Sign up for your State’s Pharmaceutical Assistance Program (if one exists in your state). Screening and applications for these programs are available on www.BenefitsCheckUp.org
• Apply to manufacturer Patient Assistance Programs for free meds (if the program still serves Medicare beneficiaries). Screening and applications available for these programs are available on www.BenefitsCheckUp.org
• Apply for assistance from a co-pay foundation, if one exists for any of your medications.
• Contact your county public health department to see if they have a free medicine program.
• If you find yourself in a health crisis, go to a hospital emergency room or special clinic that provides free or low cost care for people with low incomes.
• Sign up for a drug discount card (offered by some drug stores, pharmaceutical companies, and even some states) may be able to assist people in the gap.

IMPORTANT NOTE: For people with very high drug costs who will reach the “catastrophic coverage” portion of the Medicare drug benefit (where they pay only 5% of their drug costs) before the end of 2006, it is important to note that while these strategies may save people money while in the coverage gap, they will also stretch the coverage gap out that much longer because the end of the coverage gap is tied to a person’s total drug costs.

Some Web resources on this topic:

• www.aarp.org/bulletin/medicare/medicare_part_d.html (Information on the coverage gap and how it works)
• www.AccesstoBenefits.org Local Access to Benefits Coalitions can provide hands-on, one-on-one assistance with completing the LIS application. Visit the Access to Benefits Coalition (ABC) web site to find the ABC in your area.
• www.BenefitsCheckUp.org (Find out if you or someone you know is eligible for the LIS and apply for that important benefit. You can also find out if you might be eligible for your State’s Pharmaceutical Assistance Program, and manufacturer Patient Assistance Programs.)
• www.crbestbuydrugs.org www.crbestbuydrugs.org/PDFs/MedicareReport.pdf (Information about the safety, effectiveness and cost of drugs within commonly used therapeutic categories. The Medicare report from Consumer Reports uses “Best Buy” picks to illustrate the potential savings to consumers who -- after consultation with their doctor -- switch from a higher priced drug to a lower priced drug in the same therapeutic category.)
• http://www.medicare.gov/bridging-the-gap.asp www.medicare.gov/Publications/Pubs/pdf/11213.pdf(Basic information about the coverage gap and some tips for saving money while in the gap)
• www.medicarerights.org/Copay_Charities.pdf (Information about some co-pay foundations that may be able to assist with paying some or all of the cost of prescription drug co-pays.)
• www.rxassist.org/docs/medicare-and-paps.cfm (Information on Patient Assistance Programs and how they relate to Part D.)
• www.socialsecurity.gov (Find out if you or someone you know is eligible for the LIS and apply for that important benefit.)