The Donut Hole

[PennyK]

I'm dealing with cancer this year. Because I get chemo, I had a port installed, and I got a blood clot. Now I have to use a blood thinner, which is expensive. Due to that and a few other meds, I will be hitting the donut hole this month.
Anyone else dealing with it...how are you managing?

[Downwinder]

1. Medicare extra help

https://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html

[PennyK]

2. Thanks

No, we're doing well enough on our pensions and Soc Sec to not be eligible for extra help.
It's still a bummer to have to pay hundreds of dollars for drugs, though.

[Downwinder]

3. There is also:

http://panfoundation.org/index.php/en/

The manufacturer can't help if you are under Part "D".

[PennyK]

6. Actually, it seems to say that you SHOULD have part D

I checked and one of my meds is listed, but they are "full up" and don't accept new patients for it. Thanks though.

[Downwinder]

7. PSI is another 501

https://www.patientservicesinc.org/

[moonscape]

8. There are a number of foundations, and

even for the relatively rare cancer I have, there are several foundations that help. The ones for my cancer require you be insured (which you are) and have some drug coverage. They seem to open and close enrollment based on funding so it pays to keep checking.

Other eligibility requirement is that one's income not be > ~500% of poverty level. They don't look at assets.

My chemo drugs blew me in and out of the donut hole by mid-January! I have a grant for up to 10K for the year, and that covers the co-pay for my oral drugs. Another foundation for my particular cancer has the same requirements, but also reimburses all my insurance premiums (Part B, Part D, and MediGap.)

You might want to research which foundations have grants for your cancer. And keep checking back even the ones which temporarily aren't accepting new applicants. It could open up next month.

[PennyK]

9. Well, then, I guess we're rich

Our income seems to be just a bit over the numbers these organizations will help at.
All I'll have to pay for will be the meds to get me through my three remaining chemos and the blood thinner I'll have to use as long as I have the port; I'll have to keep doing the Herceptin for a full year.
Now I think I can switch to a pill, rather than the Lovenox injection once I have surgery this August and that will cut down the cost a lot. Otherwise, I might just end up getting past the donut hole.

Again, I'm not really complaining. I'm extremely happy that I hit 65 and that we got a Plan F supplemental at the right time. Other than meds, I've paid exactly $10 out-of-pocket for medical expenses.

[NV Whino]

4. I hit the donut hole a few years ago when I had a problem.

There is a semi solution. Have your meds administered in Outpatient Services if you can. When you do that, it falls under a different designation and keeps you out of the donut hole. May not work in your case, but it's worth looking into.

[PennyK]

5. Appreciated

That's why my chemo drugs don't count toward my drug plan. But the others are all given at home.
I get an anti-nausea drug that's very costly. My nurse very kindly found me some samples and that's helped a great deal.
And I know there are people much worse off than the Hubber and me...we can afford to pay if we have to; it's just that nobody wants to pay hundreds for drugs.

[PoindexterOglethorpe]

10. I understand that the donut hole is in the process of going away.

Won't help you this year, but it should be a consolation moving forward.