Some on Medicare D are already reaching the “donut hole”- the point where they are responsible for the full cost of their drugs. Under the standard drug benefit, the government subsidizes the drug costs for seniors and the disabled. But after costs reach $2,250, the subsidy stops until a beneficiary has paid out $3,600 of his or her own money. Then, the government will start picking up 95 percent of each purchase. Congress designed the drug benefit to give people some help with their initial drug costs, plus help those who have massive expenses. The doughnut hole was designed to reduce the overall cost of the program and still allow the federal government to meet those two goals.
About 6.9 million Medicare beneficiaries will have to deal with a gap in their drug coverage at some point this year, according to estimates from the Kaiser Family Foundation, a health policy research group. Analysts say that most beneficiaries who hit the doughnut hole probably won't get there until the fall. Medicare officials point out that, even with the doughnut hole, millions of seniors are getting financial help that they never had before. They also stress that the poorest of beneficiaries will get extra help to cover their medications. Some beneficiaries pay higher monthly premiums to make the doughnut hole smaller or do away with it entirely. However, there are beneficiaries who are convinced they will be worse off, many of whom had relied on free medicine provided by the drug manufacturers. They were told by the manufacturers this year that the free supplies would stop now that they were eligible for Medicare coverage.
Mark McClellan, administrator of the Centers for Medicare & Medicaid Services, stresses that the beneficiaries may be able to avoid the doughnut hole entirely by switching to generic drugs or lower-cost brand names. Consumers Union, publisher of Consumer Reports, says that senior citizens taking five commonly prescribed drugs -- for high blood pressure, cholesterol, heart disease, arthritis pain and depression -- could save between $2,300 and $5,300 a year under various Part D plans by switching to lower-cost drugs.
Lawmakers are also pleading with drug manufacturers to continue with patient assistance programs that allowed many low-income people to get free medicine. "We've got a situation where it looks like the May 15 date has become an excuse for dropping the assistance that many Medicare beneficiaries rely on, and that's not right," said Sen. Charles Grassley, R-Iowa.
-Find original version of this article at: http://www.cnn.com/2006/HEALTH/04/27/medicare.doughnuthole.ap/index.html
04/06