Medicare's "Doughnut Hole" Drug Coverage Gap

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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:

  1. 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.
  2. 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.
  3. 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.

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Comments   

0 nita 2010-08-28 11:08
My Doctor has prescribed Humeria and its over 4,600 a month. Im in the do-nut hole. We make just a bit more to qualitfy for state assistance.
I wish I could find more information for my delemma
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0 cathie 2010-08-26 20:47
my father in law needs help paying for his medicine hes on a fixed income and has already met the doughnut hole one prescription tody was 415.00 and another one was 172.00 he cannot afford his meds any ideas on how i might get help for him he has medicare a,b and d drug coverage he had cancer and has diabetes thanks please any help would be appreciated
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0 Kathleen 2009-06-25 06:04
Donut hole coverage is a joke. The plans which have it only cover the cheap generics during the donut hole, so there wouldn't be much benefit in paying a much higher premum in order to save a few dollars a month for otherwise cheap drugs. The kind of donut hole coverage that is needed is on that will cover the expensive drugs that put a person in the donut hole in the first place and keep that person there bleeding them dry.
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0 anonymous 2008-10-26 00:48
Thank you for sharing this vital information
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0 Guest 2008-07-08 11:50
health care provider seeking helpful information to pass on to clients~ thanks
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