Medicare Beneficiaries Face Drug Coverage Gap
Millions of Medicare beneficiaries "will have to find a way to survive Medicare's notorious doughnut hole," the San Francisco Chronicle reports. Under that provision of the Medicare prescription drug benefit, beneficiaries are responsible for 100% of prescription drug costs between $2,250 and $5,100.
Medicare drug plans generally cover 75% of drug costs after a $250 deductible up to $2,250, and then 95% of prescription drug costs beyond $5,100. According to a study by PricewaterhouseCoopers, about 3.4 million beneficiaries, or about 8% of those enrolled in the drug benefit, will reach the coverage gap this year.
Although the doughnut hole "has been well publicized," many beneficiaries "are unaware of it, don't fully understand it or hit it sooner than they expected," the Chronicle reports. Some beneficiaries receive warning notices from their drug plans as they approach the coverage gap, but others are "discovering a doughnut hole only when they visit the pharmacy and find their [copay] replaced by bills for hundreds of dollars," according to the Chronicle.
In addition, "the prospect of continuing to pay premiums for virtually no coverage frustrates many seniors," the Chronicle reports.
Diana Gray, program manager for California's Health Insurance Counseling and Advocacy Program, said beneficiaries who hit the doughnut hole but are unlikely to spend enough to reach the catastrophic coverage level by the end of the year should consider purchasing prescriptions outside of their plan's pharmacy network if doing so would be less expensive. In addition, beneficiaries should consider drug discount card programs offered by pharmacy chains and other companies, she said.
Beneficiaries who reached the doughnut hole this year might want to consider purchasing a 2007 plan with coverage during the gap, Gray added.
Robert Goldberg, vice president at the Center for Medicine and the Public Interest, said, "People are saying they can't afford it when they hit the doughnut, and I'll take their word for it. But what were they doing before (when) there was just a hole, and no doughnut?" (Colliver, San Francisco Chronicle, 8/15).
Fifty-five percent of Medicare Advantage plans did not mention in the summary of benefits sections of their marketing materials that the list of drugs covered by the plan could change, according to a report released on Monday by HHS Office of Inspector General, CQ HealthBeat reports. The report examined a random sample of marketing materials from 36 MA plans from January 2005 through December 2005.
The report does not cover marketing materials for the Medicare prescription drug benefit, which began on Jan. 1. The report finds:
- 18% of plans did not specify that beneficiaries could submit appeals to attempt to receive coverage for an uncovered drug;
- 10% of plans did not identify coverage limits for prescription drug benefits;
- 52% of plans did not provide operating hours for customer service call centers; and
- 10% of plans listed phone numbers for individuals with hearing impairments in a different font size and style than other phone numbers.