HealthBridge's In-Home Care Blog

Like Juliet says as she's leaving Krispy Kreme, "a doughnut by any other name would taste as sweet."

You see, it's the warm, sugary, an-extra-hour-on-the-treadmill-is-worth-it goodness that makes doughnuts what they are.

Just calling something a doughnut doesn't make it delicious.

Certainly calling the $4,000 black hole in the middle of your Medicare prescription drug benefits a "Doughnut Hole" doesn't make it any sweeter.

The so-called Doughnut Hole is the bitter pill Medicare members have to swallow each year as they reach the middle of their drug benefit. For some seniors with expensive meds, this comes early in the year. For others, their benefit runs out in the winter and doesn't start back up until the new year.

One thing is for sure, it's a rare and healthy senior indeed that can avoid the precarious Doughnut Hole.

Here's how it works:

After a $295 deductible is met, Medicare's prescription drug coverage picks up the tab for 75% of drug costs up to $2,700. While your costs are $2,700 - $6,154, Medicare does not cover any part of the drug cost. After $6,154, Medicare pays 95% of the tab. The $4,350.25 that Medicare beneficiaries pay out of pocket in the middle is considered the doughnut hole.

Extra Help - New and Improved

There is a federal program to help people get through the Doughnut Hole called the Extra Help program. As one of my favorite Senior Care Advocates, Paula Span, writes:

Extra Help subsidizes the cost of the Medicare Part D prescription drug program; it pays part or all of the monthly premiums and also reduces co-pays at the pharmacy. "For most people, the infamous doughnut hole gets totally closed up," said Hilary Dalin, associate benefits director for the National Council on Aging, referring to the point at which Medicare stops paying and older people themselves must shoulder thousands of dollars in drug costs before coverage resumes. "It lifts a huge burden from people who qualify."

But qualifying was always the problem. The income limits for Extra Help are already low, and strict eligibility requirements made qualifying harder in two ways: by including the cash surrender value of life insurance policies as an asset, and by counting any gift as income. "If your granddaughter came by once a week with a bag of groceries, that counted as income," said Ms. Dalin. "Until Congress said, ‘No more.'"

Extra Help provides a lot of extra help - an average of $4,000 per year, in fact.

So, who qualifies?

Extra Help is for people with income and asset limitations. It's also designed to help with Medicare's benefit gap. You should apply for Extra Help if you:

• Have Medicare Part A (Hospital Insurance), Part B (Medical Insurance), Medicare Drug Coverage
• You live in one of the 50 states or DC
• Your assets (excluding your your primary residence) are less than: $25,010 married and living with your spouse or $12,510 not married or not living with your spouse
• Your income is less than: $21,855 married or $16,245 single

You can apply online on the National Council on Aging's Benefitscheckup.org website. It has the full application for Extra Help, plus will direct you to other public, private, federal and local programs that are available to you.

So, now you can get the extra help you need to pay for your prescription drugs and have a few bucks left over for a couple glazed delights.

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