South Caroilna Increases Prescription Help for Low-Income Seniors

Low-income senior citizens in South Carolina who qualify for help paying for their prescription drugs will be getting a little more help starting January 1. State lawmakers increased the amount the state will pay for from 10 percent up to 30 percent.

Medicare Part D pays for the prescription drugs of senior citizens who qualify, but only until they’ve used $2,700 worth of prescriptions. After that, the senior citizen is responsible for the entire cost. If and when they’ve spent $6,153.75, the Medicare coverage starts up again. That gap between $2,700 and $6,153.75 is known as the “donut hole”.

The state has a program to help cover that gap, the Gap Assistance Pharmacy program for Seniors, or GAPS.

Jeff Stensland, spokesman for the South Carolina Department of Health and Human Services, says, “When it was originally created it covered 95 percent of the donut hole. Then, because of, unfortunately, because of the state budget cuts that we went through, we had to reduce that to 10 percent of the donut hole. Now, because we received some additional funding through the General Assembly for next year, we’ll be able to take that coverage up to about 30 percent of the donut hole, which is good news for a lot of people who depend on that assistance.“ 

He says about 25,000 South Carolinians qualify for the program but he doesn’t know how many actually reach the “donut hole” and receive assistance.

So why is there a donut hole to begin with? Why not just cover all of a low-income senior citizen’s prescription drug costs? Because of the cost. When Congress created the program there was no way to cover everyone, so lawmakers compromised and decided to cover only those with the least amount of prescriptions and those with the most. That created the donut hole in the middle.

And U.S. Sen. Lindsey Graham, R-South Carolina, says even with the gap the entire prescription drug program is draining tax dollars too fast.

“I don’t want to fill the donut hole unless we fix Medicare completely,“ he says. “Medicare is on an unsustainable growth. It’s grown by 2200 percent since 1980. We need to reform Medicare, Medicaid and our entire health care system and I want to do it as a package.“

He says in 20 years, Medicare, Medicaid and Social Security combined are going to equal the entire current federal budget. “Helping low income seniors is a necessity. Being everything to everybody from the government’s point of view is bankrupting this country,“ he says.

So who qualifies for South Carolina’s GAPS coverage? Generally, it’s seniors whose income falls between 150 and 200 percent of the federal poverty level, according to the state Department of Health and Human Services.

“One thing we’d like people to remember is if there are folks out there who are really struggling, we do encourage them to call Social Security Administration, because if you’re low income enough there is no donut hole at all and the federal government will pick up the cost that would otherwise be that coverage gap. So for those who are struggling, it’s important for them to at least call and check to see if they would qualify for that,“ Stensland says.

The Social Security Administration’s number is 1-800-772-1213. Ask about the “Extra Help” program.

For more information from HHS about the state GAPS program, go here.

You can also get more information at the Lt. Governor’s Office on Aging here.