Health Team

Look for Better Deals to Avoid Medicare's Coverage Gap

Posted April 5, 2007
Updated April 9, 2007

— Between 3 million to 7 million Medicare beneficiaries will hit a coverage gap this year and may pay thousands of dollars out of pocket or do without the medication. However, experts said the gap can be delayed with wise shopping for medication deals.

Stefanie Ferreri, a community pharmacist at the University of North Carolina at Chapel Hill, spends a lot of time, not just answering questions about medicine, but about the new Medicare plan for prescription drug coverage. Some people thought they understood the plan, but Ferreri said she has found that people did not understand the gap in coverage.

Once you pay your Medicare deductible, your coverage will kick in, but only in a short period of time.

"Once you hit that limitation, you have to pay 100 percent out of pocket for your medicine," said Ferreri.

However, Ferreri said the early coverage can be stretched with wise shopping. For example, many prescription medications have an over-the-counter version.

"It might be an expense out of pocket, but it's going to be a lot more inexpensive version over the counter than if it were a prescription," Ferreri said.

You may spend $23 out of pocket now for an over-the-counter version, but that makes your early coverage last longer and delays a time when you might have to pay much more when you hit the coverage gap.

For example, a prescription to Nexium with 30 tablets can cost $178. However, Prilosec, which is available over-the-counter, in some pharmacies can cost $23. Zaditor, an over-the-counter eye drop medicine for allergy relief, costs about $13. The prescription form, Patanol, goes for $90 a bottle.

Ferreri said the biggest savings in medications is in generic brands.

"Making sure that your doctor prescribes a medicine that does have that generic available will help that money go a longer way," she said.

If someone's doctor did not prescribe a generic version, Ferreri advises customers to ask their pharmacist if a less-expensive generic version is available.


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  • WXYZ Apr 10, 2007

    Attention, People on Medicare! Also, carefully read and question the coverages and exclusions on your Medicare HMO insurance policy. This especially pertains to any policy with United HealthCare, Aetna or Cigna. You PAY LESS for these HMO's, but you GET FAR LESS in terms of coverage of medical problems and CHOICE of health care provider. Just be sure that you understand and can accept the tradeoff: less money = less health care + less choice.

  • kmason910 Apr 9, 2007

    Check the Wal-Mart $4.00 generic list. If you do not normally get your prescriptions there, you can move a prescription there and not file it on your drug plan. Then the costs do not go towards your total. I moved four of mine. Every little bit helps.