Medicare's "Doughnut Hole" Drug Coverage Gap
- Created on October 20th, 2006
- By Brian Poger
Senior Educators is an organization that provides enrollment assistance and education on Medicare plans
A report released by Senate Democrats found that 88 percent of Medicare beneficiaries in standalone prescription drug plans are enrolled in plans that have gaps in drug coverage, commonly known as the "doughnut hole."
Advocates for seniors declared September 22, 2006, a symbolic "Doughnut Hole Day" to educate beneficiaries on the gap. Advocates calculated that September 22 would be the date at which the average amount of money spent per Medicare Part D plan beneficiary reached the gap threshold of $2,250. During the coverage gap, beneficiaries must pay for 100% of drug costs until their total out–of–pocket costs equal $3,600.
A nationwide survey of Medicare beneficiaries released last week by the Medicare Rx Education Network found that almost half (47%) of respondents enrolled in a Medicare drug plan were not aware of the gap in coverage or "doughnut hole."
Although the majority of Medicare beneficiaries will not reach the drug–coverage gap, seniors need to know the facts. The new Medicare drug plans have benefited many seniors, but there is still a serious need for more information. We are working to address the need, especially concerning the important issue of the prescription–drug coverage gap.
The survey also found that almost 8 out of 10 (78%) respondents were not aware that they could enroll in a plan that offers coverage–gap protection. There are several prescription drug plans currently available offering coverage during the gap period, including those offered by popular healthcare providers WellPoint, UnitedHealth and Humana. This morning’s Senate report found that nationwide only 12 percent of beneficiaries were enrolled in a plan offering coverage in the drug gap.
In a June analysis, Price Waterhouse Coopers LLC estimated that the gap in coverage will likely affect 3.4 million Americans enrolled in Medicare Part D. Beneficiaries enrolled in both Medicare and Medicaid, known as dual–eligibles, are not subject to the coverage gap.
For more information, call the Senior Educators Advice Line at 1–800–505–8515 Monday–Friday from 9 a.m. to 5 p.m. and Saturdays from 9 a.m. to noon. Help is also available online at www.SeniorEducators.org.
Tips to Avoid the Doughnut Hole:
- Add up your drug costs. Figure out how much money you’ve spent so far on drugs so you can plan ahead and know how much time you have before you reach the coverage–gap threshold.
- Ask for generic drugs when possible. Many seniors use name–brand medications when there are appropriate generic drugs available, increasing the chance that their drug spending will reach the coverage gap threshold.
- Look into plans now without gaps in coverage for next year. The enrollment period for 2007 officially begins November 15, but early research helps avoid problems down the road.
About Senior Educators: The search for better, more affordable healthcare coverage through Medicare Prescription Drug and Medicare Advantage plans can be a daunting task. Senior Educators is dedicated to providing unbiased guidance and free expert enrollment services to Medicare recipients to help make obtaining high–quality healthcare as simple and affordable as possible.