When Medicare D went into effect two years ago, it promised seniors help with prescription drug costs, and it has helped many people. But the plan also includes a large gap in coverage – known as "the doughnut hole," which forces those with high drug costs to pay for them out-of-pocket during part of the benefit year. Many Vermonters are more fortunate than seniors in other states because V-Pharm, a state drug assistance program, covers this gap. But even if you are not eligible for V-Pharm, you can still take steps to avoid the doughnut hole's worst effects.

In 2008, the gap in the standard Medicare drug benefit starts when your total drug costs reach $2510, including the amount paid by your part D plan and your own out-of-pocket deductibles and co-payments. You must then pay the full costs of your medications yourself, an additional $3216, not including your continued payment of monthly premiums, before you get out of the doughnut hole and are eligible to receive catastrophic coverage. At this point, Medicare will pay 95 per cent of your drug costs for the remainder of the benefit year.

"We've gotten calls for help from people who have reached the doughnut hole as early as April," says Gail Ireland, coordinator of the State Health Insurance Assistance Program at the Champlain Valley Agency on Aging. That means that they have reached the coverage gap less than four months into the year. Even if you have already chosen your Medicare D plan for 2008, it is not too late to plan for the coverage gap.

Here are some suggestions from Ireland:

• Find out about V-Pharm, the state pharmaceutical assistance program. V-Pharm acts as a secondary payer when you have Medicare D, paying for premiums, co-pays, and deductibles, and coverage through the doughnut hole. There is no asset requirement, but the monthly income eligibility maximum is $1915 for an individual, $2567 for a couple. Contact: Vermont Health Access Member Services, 1-800-250-8427.
• Talk to your doctor about generic drugs. You may be able to avoid the doughnut hole altogether if you can substitute lower-priced generic medicines for more expensive brand name ones. "You should have this conversation with your doctor whether you are rich or poor," says Ireland.
• Find out about free samples and patient assistance programs from drug manufacturers. Every manufacturer has different guidelines, but some computer programs can help you sort through the maze. Go to: www.rxassist.org or  www.needymeds.com
• Buy your medicines in Canada. Vermont has joined Illinois, Wisconsin, Kansas, and Missouri in a multi-state agreement that helps people buy their drugs more cheaply and safely through licensed, inspected pharmacies in Canada and the United Kingdom. Information: call 1-866-472-8333, or go to: www.I-SAVERX.com
• Contact Fletcher Allen Health Care's Health Assistance Program. Designed to assist patients who are uninsured or under insured, this is a resource and referral program for people whose monthly incomes are at or below $2553 for an individual, $3423 for a couple. Staff can screen people for state and other assistance programs, offer advice about purchasing medicines at lowest cost, work with providers to explore generics and find free samples, and authorize payment for some medications for up to $200 per person per year. Contact: Jennifer Daley, 802-847-6984, afternoons from 1:00pm – 4:00pm.
• FAHC is a member of the Vermont Coalition of Clinics for the Uninsured, an organization of eight other clinics, including one in Middlebury, which offer these services. Contact: Sonja Olson, VCCU Coordinator, P.O. Box 1015, Middlebury, VT 05753; 802-388-2753.
• Contact Chittenden Community Action's Prescription Assistance Program. You can receive up to $100 per year in drug costs if you are eligible – living in Chittenden County with a monthly income at or below $1574 for an individual, $2110 for a couple. This program works with the Rite Aid pharmacy on Cherry Street in Burlington. Contact: Chittenden Community Action, 191 North Street, Burlington, 863-6248.
• Check out prices at Wal-Mart. They feature a 30-day supply of 360 prescription drugs for $4.00. See if your medicines are on their list – www.walmart.com/pharmacy. Or call the Wal-Mart in Williston, 802-878-5233.
• If you are a veteran, the Veterans Administration may be able to help you, depending on your VA status and the type of medications you use. Call the VA at 1-866-687-8387.
• If you have not chosen your Medicare D plan yet for 2008, be sure to compare plans through the Medicare D web site at www.Medicare.gov. Although a plan may seem reasonable because it includes a low premium and coverage during the doughnut hole, says Ireland, it may actually be more expensive than others, depending on the specific drugs you need. The Medicare web site asks you to list all of your medications before it totals your actual cost for each plan.

Why not avoid signing up for Medicare D altogether, especially if you have little or no drug expenses? "I would hate to tell people to forego Medicare D," says Ireland. "No one can predict what medications he or she may need down the line. Then, if you change your mind, the penalty for signing up late can be severe: one per cent of the current national average premium for every month that you did not enroll after you became eligible."

You can get free Medicare counseling with detailed assistance about Medicare D from the State Health Insurance Assistance Programs available at each agency on aging in Vermont. If you live in Chittenden, Addison, Franklin, or Grand Isle counties, call 802-865-0360 or 1-800-642-5119.

Barbara Leitenberg writes on senior issues for the Champlain Valley Agency on Aging. This article originally appeared in the Burlington Free Press.