medicare doughnut hole

05 Feb: Study: Medicare coverage gap is forcing seniors to skip their meds

We’ve written here frequently about the “doughnut hole” in Medicare Part D. This is a coverage gap that, in 2009, requires seniors to begin paying full price for their prescription drugs if they exceed $2,700 in total drug costs. Contrary to what many seniors believe, the $2,700 isn’t based on out-of-pocket expenditures, but the total cost of their drugs, including the covered portion. So a senior will typically pay less than $1,000 out of pocket before hitting the coverage gap. And here’s where the doughnut hole becomes a chasm. Coverage doesn’t kick in again until the senior has paid a whopping $4,350 out of pocket. About a quarter of Medicare Part D enrollees — more than six million seniors —…

29 Dec: Consumer Reports on Canadian drugs

Consumer Reports says buying prescription drugs from Canada can be a smart strategy for cost-conscious consumers. Here’s the magazine’s advice: You can often save 25 percent or more [using mail-order pharmacies]. Buying brand-name medications from Canada can boost your mail-order savings, sometimes up to 50 percent. Generics, however, are cheaper in the U.S. And drugs bought in Canada will not count toward your Medicare Part D deductible. While it’s illegal to buy drugs from foreign countries, including Canada, because of safety concerns, the FDA may refrain from taking legal action if you can provide your doctor’s name, address, and phone number, and confirm that the drugs are for personal use. If you wish to explore this option, look for pharmacies…

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…

08 Oct: It’s not just the elderly who can’t afford prescription drugs

  Those who would minimize the crisis that is the U.S. healthcare system would have you believe, among other things, that the problem of high-priced prescription drugs mostly affects the elderly — who supposedly have gotten the relief they need from Medicare Part D and a multitude of state programs. This is simply not the case. The Los Angeles Times reports on a pharmacy benefit manager’s study that states: …nearly 70 percent of adults aged 25-34 claim the economic downturn of the last 12 months has made it somewhat or significantly more difficult to pay for health care expenses … Overall, three out of four people are concerned about the cost of health care… The Times speculates as to the…

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…

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 drugs…