The following organizations provide information and/or with assistance in obtaining prescription medications for eligible individuals.
Q: I need a Medicare Part D plan (prescription drug). Who can help me?
A: The Seniors’ Health Insurance Information Program (SHIIP) is a division of the NC Department of Insurance. SHIIP counsels Medicare beneficiaries and caregivers about Medicare, Medicare supplements, Medicare Advantage, Medicare Part D, and long-term care insurance. The counselors offer free and unbiased information regarding Medicare health care products. Locally, The Shepherd’s Center of Winston Salem, the Forsyth County coordinating site, has certified volunteer counselors and offers one-on-one Medicare counseling throughout the year.
Q: My medication copays have increased and they tell me I am in the donut hole. What is the donut hole?
A: Most Medicare Part D plans have a coverage gap, sometimes called the Medicare donut hole. This means that after you and your Medicare drug plan have spent a certain amount of money for covered prescription drugs, you then have to pay all costs out-of-pocket for the drugs, up to a certain limit. The yearly deductible, co-insurance, or co-payments, and what you pay while in the coverage gap all count toward this out-of-pocket limit. The limit doesn’t include the drug plan’s premium. There are plans that offer some coverage while you’re in the gap, for generic drugs, for example. However, plans with gap coverage may charge a higher monthly premium. Check with the plan first to see if your drugs would be covered during the gap. Once you reach the plan’s out-of-pocket limit during the coverage gap, “catastrophic coverage” automatically kicks in. Catastrophic coverage means that when you’ve spent up to the plan’s out-of-pocket limit for covered drugs; you will only pay a small co-insurance amount or a co-payment for the rest of the year.