medicare coverage gap

17 Oct: The doughnut hole is getting bigger; would Obama or McCain plug it?

BusinessWeek published a story this week on “Medicare’s Costly Doughnut Hole,” which mostly rehashes a survey from the Kaiser Family Foundation (reported here previously) that shows many seniors forgo needed medications rather than pay full price for their meds. The story also reports that the doughnut hole is getting bigger… The doughnut hole is exacerbating a growing Medicare financial burden on seniors. On Sept. 26, health-care advisory firm Avalere Health released a report predicting Part D beneficiaries will see their premiums rise 24% on average, to $37 a month, in 2009. Those who joined the 10 most popular plans will swallow a 30% increase … Some drug companies offer assistance programs, Fletcher says, but only for the lowest-income seniors, and…

14 Oct: Scrutinize your insurance options wisely for the best deal on drugs

  We talk a lot on this blog about the 65 million Americans without prescription drug insurance, and the millions of additional seniors who fall into the Medicare doughnut hole every year. But for those of you fortunate enough to have an employer-sponsored health insurance plan, we know that life isn’t a bowl of cherries for you, either. As Sandra Block writes at USA Today: The average employee’s health care costs, including premiums and out-of-pocket expenses, will increase 8.9% in 2009, according to Hewitt Associates. That’s well above the rate of inflation and average salary increases… For that reason, it’s more important than ever to scrutinize your employer’s health care options during open enrollment season. Don’t assume the plan you…

22 Sep: Get out your party hats; it’s Doughnut Hole Day

From the Sarasota Herald-Tribune: In health care circles, Monday is Doughnut Hole Day, the deceptively storybook name for a nasty plot turn in the drama of getting prescriptions filled when you’re over 65 and living close to the bone. The hole is the gap in coverage built into Medicare’s Part D prescription drug program, which pays most of the first $2,250 in patient prescriptions and 95 percent of drug expenses over $5,850. Doughnut Hole Day is the point on the calendar at which large numbers of people with chronic illness begin to exceed $2,250 in drug costs, leaving them to pay full price for their prescriptions until they have spent $3,600 out of pocket. An August Kaiser study showed that…

28 Jul: Medicare Part D has been a great program for pharmaceutical companies

Jacob Goldstein at the Wall Street Journal Health Blog reported Friday: It was dueling reports yesterday on Capitol Hill, as Democrats argued that Medicare is paying way too much for prescription drugs and Republicans countered that the spending is on target. Henry Waxman, chairman of the House oversight committee and a longtime critic of the Medicare Part D drug benefit, … released [a] report, which looked at drug costs for so-called “dual eligible” patients whose drug coverage was switched from Medicaid to Medicare in 2006. The report found that Medicare Part D pays 30% more for drugs than Medicaid, a discrepancy worth more than $3.7 billion for drugmakers in 06 and 07. Not to be outdone, the Republicans on the…

22 Jul: Medicare Part D nightmares, continued

  We all know — or should know — by now that the Medicare prescription drug benefit (Medicare Part D) was crafted with the needs and convenience of Big Pharma, rather than patients, in mind. That’s why it’s so unwieldy for the consumer. The worst part about Medicare Part D is the so-called “doughnut hole,” described by the Wall Street Journal as “the notorious gap in coverage … where (beneficiaries) generally must begin paying the full cost of their medicines. The doughnut hole kicks in when total drug expenditures by the beneficiary and the plan reach $2,510.” Another egregious element of Medicare Part D, which has gotten less attention, is private “pharmacy benefit managers” charging Medicare beneficiaries MORE for prescription…