Scan Medical Insurance

Health Insurance for my 87 year old mother.?

My Mom must take three very expensive medications each month, non of which are available in generic form. Lately, she has been tested for Pulmonary Arterial Disease and requires many tests by specialists, but MediCare says for 2008 she has reached her "donut hole" and will have to pay everything out of pocket for the rest of the year! Her meds alone are about $700 per month. AARP has been handling her medical insurance and delivering her meds by mail. By the way, her income is social security and she is widowed. Any suggestions? Can someone also explain the "donut hole" to me so that I am better informed to help her? Thank you to all serious responders.

Public Comments

1. Medicare has set up the drug coverage with 4 stages, as follows: Stage one - there is a $275 deductible. Most plans do away with the deductible. Stage two - you go into "initial coverage" where you pay 25% of the drug costs. Most plans have the 25% as a simple co-pay. Stage three - when you AND the insurance company has paid $2510 for the drugs you go into the coverage gap, or "donut hole" where you pay 100% of the drug cost. (You don't actually pay 100% of the retail cost because each insurance company has negotiated the cost of each medication with the pharmaceutical companies. You pay 100% of the negotiated cost. This negotiated cost will vary by insurance company) You stay in the donut hole until you've paid an out-of-pocket cost of $4050 (this includes the amount you pay for any deductible and copays during the initial coverage). Some plans will have generics covered through the donut hole. After paying $4050 you go into Stage four - catastrophic coverage, where you are paying 5% of the drug cost. Again, most companies will have this as a simple co-pay. If her drugs cost $700 per month she'll be in the donut hole just under 5 months and will then go into catastrophic coverage. At that time her meds will be approximately $35 depending on the med and the exact plan she has. The donut hole only refers to drug coverage. Her health plan does not have a donut hole for the medical costs so she'll still get medical treatment as per the plan benefits. She may want to visit a local agent that works with all the major plans in her area. A good agent can do an analysis of her medications and can inform her of the costs before, during, and after the donut hole. AARP is a good plan but I find that the drug coverage with them is generally higher than many other companies.