‘Doughnut Hole’ Affects Most Medicare Beneficiaries
Almost half of Medicare beneficiaries enrolled in prescription drug plans in 2006 were in plans that required them to pay the full cost of their medications during the so-called "doughnut hole," according to a report by the Kaiser Family Foundation published Tuesday on the Health Affairs Web site, the Oakland Tribune reports (Vesely, Oakland Tribune, 11/21).
The coverage gap in 2006 means that beneficiaries are responsible for all drug costs once they reach $2,250 in total drug spending. Once beneficiaries have spent $3,600 out of pocket, the drug benefit will pay 95% of costs. Next year, the catastrophic limit will be $3,850 (Kaiser Family Foundation release, 11/21). Nearly half of all Medicare beneficiaries, or 10.9 million people, in 2006 are enrolled in plans that make them responsible for 100% of costs if they reach the doughnut hole, the study said.
About 4% of beneficiaries in 2006 have drug plans that help with costs in the doughnut hole, and 8% of beneficiaries have coverage during the doughnut hole only for generic drugs, according to the study (Oakland Tribune, 11/21). Further, 9.3 million beneficiaries with low incomes in 2006 qualify for subsidized drug coverage during the doughnut hole. In 2007, most Medicare drug plans will include a coverage gap, the study said (Kaiser Family Foundation release, 11/21).
The study found that of 266 companies offering Medicare drug plans in 2006, 10 accounted for 72% of the market.
UHC PacifiCare and Humana "dominated the marketplace" with 25% and 19% of total enrollment, respectively, the Tribune reports.
In addition, the study found that United AARP's Medicare Rx and Humana's Standard Plan accounted for 23% of Part D enrollment nationwide (Oakland Tribune, 11/21).