Monday, September 25, 2006

Doughnut Hole

WaPo reported Millions of older Americans are confronting a temporary break in their Medicare drug coverage this month that will require them to pay the full cost of their prescriptions or face the painful prospect of going without.

Before part D was enacted, they would have been paying for all of them all along.
This is the "doughnut hole" in the new Medicare drug benefit that began in January, and advocates for seniors say there is nothing sweet about it. Some seniors knew nothing of the coverage gap until they were hit with a bigger drug bill, advocates say.
Then they were not paying attention. I knew about it from the start. I decided not to sign up for Part D because the premiums would be more than my drug costs, but I knew if I had, the doughnut hole was there.
"Virtually everyone who calls to say they've been denied coverage, they're shocked," said Robert M. Hayes, president of the Medicare Rights Center, a nonprofit that helps seniors navigate Medicare. "Trying to explain that this is the way the program was created by Congress angers folks who think it makes no sense. Many people feel blindsided."
Would they have preferred paying for all of their drugs all year, or would they have preferred to pay more up front to avoid the doughnut hole?
The coverage gap was one of the most contentious elements of the 2003 legislation that created the new benefit. It ends federal payments for a person's drug purchases once an annual spending limit is reached, resuming them only after the beneficiary has spent thousands of dollars out of pocket.

Proponents saw the unusual setup as a way to provide some help to all beneficiaries, and substantial help to those with catastrophic drug costs, and yet not break the bank in a federal program that is expected to cost hundreds of billions of dollars over the next decade.
Precisely. They could have paid more up front and avoided the doughnut hole, but that would have been more unfair to those that did not need that many prescriptions. I think doctors prescribe a lot more than people really need. With too many drugs you get serious drug interactions.
Nine months into the program, as more and more seniors reach the threshold that puts them in the gap, many see it as a headache -- or worse.

Frances Acanfora, 65, had been paying $58 for a three-month supply of her five medications. But this month the retired school lunchroom aide learned that her next bill would be $1,294. She had entered the doughnut hole.
Without the program, she would have been paying $1294 all along.
"It's not my fault that I take this medicine," the Brooklyn resident said. "I've got to take it. And they make a limit. That's not fair."
Who made a limit? They paid for a lot of your drugs, but not all of them? That is not a limit.


Anonymous said...

Re your comment: "Before part D was enacted, they would have been paying for all of them all along."

Granted I don't know that the following specifically applies to the woman referenced in the article but it does to many.

FYI, Actually in many cases that is not true. I have a relative that pre-Part D was getting 3 very expensive meds FREE from the manufactures. Before the May deadline the 3 co's sent a letter stating that the govt had determined that regardless of if someone actually applied for Part-D or not the manufacturers would be forbidden from VOLUNTARILY giving THEIR meds out for fee to anybody that WOULD have been given access to Part-D if they had applied & also to those that DID apply & were given Part-D 'benefits'. They said the reason for this is what is usually referred to as "double dipping".

Now IMHO, it is one thing for the govt to say that if someone DID get Part-D 'benefits' that it might be "double dipping". However, I see in no way whatsoever how it could be viewed as such if the person hadn't even APPLIED let alone wasn't actually even on Part-D. At the time my relative received the letters I called Medicaid & asked them if the govt had actually made such a determination & I was told that they had.

So even though my relative didn't need the Part-D she had to apply for it ANYWAY b/c if she did not come the deadline she WOULD need it b/c the drug co's would have been prevented from giving her the free meds. So she went from paying absolutely NOTHING for those 3 expensive drugs (thru the generosity of the manufacturers) to paying for them. Then there is this doughnut hole business.

BUT THEN.........It got worse for my relative....

A month AFTER she got on Part-D (by the deadline) she THEN got a letter saying that the govt had PARTLY changed their mind. The letter stated that the govt no-longer considered it "double dipping" if the person DID NOT APPLY FOR/WASN'T ON Part-D, however, if they WERE ON Part-D then the person couldn't get the free meds incl during the "doughnut hole" period (in which they, the patients, can't get Part-D 'benefits').

How fricking convenient that the govt says this after probably 1000's of people (but definitely my relative) who had, pre-deadline, been getting free meds but under pressure/threat of no med cost help at all applied & were given Part-D 'benefits' that have a "doughnut hole" where there are no 'benefits' at all along w/ the other associated costs of the Part-D coverage. Also, if they had made the determination stated in the 2nd letter in the 1st place then those folks that didn't need Part-D wouldn't be on it AND the govt/the program wouldn't have THEIR associated costs for those type of persons (incl but not ltd to the paperwork costs which alone is probably not exactly what you'd call "cheap").


Don Singleton said...

I was not aware of that. That is terrible.

Double Dipping is when you have two different government retirement programs you are eligible for. Even then I dont see a problem if you get both, because you earned both, but this situation is totally stupid