By now, some of you may have reached or are getting close to the gap, or “doughnut hole” with your Medicare Prescription Drug Plan (Part D). In 2021, you will reach the Medicare Part D gap when the negotiated retail cost of your medications add up to the $4,130 threshold. Once in the gap, you become responsible for 25 percent of the negotiated retail cost for both brand-name and generic medications. This may be a more costly out-of-pocket change.
Prescription Advantage, which is a state-run program, can assist you in this gap, and/or put a cap on your out-of-pocket cost for medications. Eligibility is based on income only, and there is no asset limit!
If you are a Massachusetts resident and eligible for Medicare, the income limits are:
- Age 65 or over: $64,400 or less for a single person, or $87,100 or less for a married couple.
- Under age 65 and disabled: $24,214 or less for a single person, or $32,750 or less for a married couple.
There is no charge for joining Prescription Advantage if you have an annual income at or less than $38,640 for a single person, or $52,260 for a married couple. However, there is a $200 per person annual enrollment fee for those with higher incomes.
If you are a member of Prescription Advantage, you are also allowed to change your prescription plan one time outside of the Medicare Open Enrollment.
You may also join if you are 65 years or older and not eligible for Medicare. If you are not eligible for Medicare, Prescription Advantage will be your primary prescription drug plan, and there is no income limit.
Medicare also has a program, called “Extra Help,” which can assist with the cost of your Medicare Part D plan’s premium, deductible, and copays. Please call the Senior Center to make an appointment with a SHINE counselor for more information on these programs or assistance with any Medicare issue. Trained SHINE volunteers offer free, confidential counseling on all aspects of Medicare and related health insurance programs.
