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Medicare Drug Program News
Confusion Surrounds Doughnut Hole in Medicare Drug
Program
Three major newspapers find lots of confusion among
seniors
July 31, 2006 – Increasing numbers of senior
citizens are falling into the infamous "doughnut hole" in the Medicare
drug program, where they must pay the full cost of their drugs. Three
major newspapers have recently focused on the confusion that surrounds
this hole in the Part D program, according to KaiserNet.org.
 Newspapers Examine Medicare Beneficiaries'
Experiences With Gap in Medicare Drug Coverage
Three newspapers on Sunday examined how some
Medicare beneficiaries have reached the so-called "doughnut hole," or
coverage gap in the Medicare prescription drug benefit. Under the
doughnut hole, beneficiaries are responsible for 100% of drug costs
between $2,250 and $5,100. Medicare covers 95% of prescription drug cost
beyond $5,100 (Kaiser
Daily Health Policy Report, 7/27). Summaries of the articles
appear below.
●
Baltimore Sun:
Some experts say many Medicare beneficiaries are unaware that the
doughnut hole exists or beneficiaries have "heard about the gap" but
"don't understand how it's calculated and are surprised when it hits,"
the Sun reports. In addition, some beneficiaries might only keep track
of their out-of-pocket drug costs, rather than their total drug costs --
a figure that is needed to determine when a beneficiary will reach the
doughnut hole.
Tricia Neuman, a
Kaiser Family
Foundation vice president and director of the foundation's
Medicare Policy Project, said, "Unless they have been keeping careful
tabs on what their total drug expenditures have been so far in the year,
they probably will have sticker shock when they go to the pharmacy"
(Ambrose, Baltimore Sun, 7/30).
●
New York Times:
The doughnut hole has been "upsetting many beneficiaries" and has
"become a potent symbol as politicians debate the merits" of the
Medicare drug benefit, the Times reports. The doughnut hole is
"attracting fresh attention ... because many beneficiaries are just now
discovering it," according to the Times.
In addition, some beneficiaries mistakenly believed
that the doughnut hole only affected drug costs from $2,250 to $3,600,
figures that were "emphasized in brochures published by the government
and insurance companies," according to the Times. The Times notes that
the $3,600 figure only includes out-of-pocket spending, which
"corresponds to about $5,100 in total drug spending."
CMS
Administrator Mark McClellan said beneficiaries will have saved $1,500
in prescription drug costs by the time they reach the coverage gap. He
added that beneficiaries concerned about the doughnut hole can reduce
their drug costs by switching to generic medications, using state
assistance programs and switching to a new drug plan next year that
includes some coverage during the doughnut hole (Pear, New York Times,
7/30).
●
Washington Post:
Some advocates for Medicare beneficiaries are expressing concern that
the doughnut hole "is misunderstood and problematic," the Post reports.
According to the Post, the "calls are starting to come in" to advocacy
groups from beneficiaries who are "shocked and angry" upon reaching the
coverage gap. In addition, some groups and health policy analysts "have
warned of serious health consequences" for low- or moderate-income
beneficiaries who exceed income requirements for assistance programs.
According to some advocates, these beneficiaries
could face "difficult choices" between buying "medicines or food and
other necessities," the Post reports. McClellan said that for the
majority of beneficiaries, the drug benefit brings "a peace of mind ...
they never had before" (Levine, Washington Post, 7/30).
APM's "Marketplace
Money" on Friday reported on the coverage gap. The segment
includes comments from Robert Hayes, president of the
Medicare Rights
Center; Charlotte Yeh, a Medicare administrator; a Medicare
beneficiary who is currently experiencing the coverage gap; and a
Medicare beneficiary who is purchasing prescription drugs from Canada to
prolong the time period before she enters the coverage gap (Palmer,
"Marketplace Money," APM, 7/28)
>> The complete transcript and audio in RealPlayer of
the segment are available
online.
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