Medicare Beneficiaries Reaching Coverage ‘Doughnut Hole’
About 3.4 million Medicare beneficiaries enrolled in the drug benefit have begun to approach the so-called "doughnut hole," the Los Angeles Times reports. The doughnut hole is the gap in coverage under which beneficiaries must cover 100% of their annual medication costs between $2,250 and $5,100.
Most of those Medicare beneficiaries "are middle-class seniors with multiple chronic illnesses," and some "have already experienced an abrupt surge in prescription costs," the Times reports. According to the Times, at "stake is a basic approach of the Bush administration and many conservatives and business leaders for dealing with the cost crisis in health care," in which they say "consumers must be made to take more responsibility for their medical affairs."
The Bush administration maintains that Medicare beneficiaries can enroll in prescription drug plans that cover the doughnut hole, although such plans have higher premiums, and recommends that beneficiaries monitor their annual prescription drug costs and use generic versions of medications to help reduce costs. In addition, "some seniors may wish to switch from traditional Medicare to managed care plans, which are more likely to provide coverage in the doughnut hole," and beneficiaries also can "anticipate the gap and save ahead for it," the Times reports.
Critics maintain that "higher premiums for blanket coverage may be beyond the reach of some," that not all prescription drugs have generic versions and that a "senior's health needs can change, making it difficult or impossible to plan ahead," according to the Times. Some physicians also have raised concerns that Medicare beneficiaries who reach the doughnut hole might not have to ability to cover the cost of necessary prescription drugs.
In response, some Democrats -- who "say the coverage gap can be closed if Congress grants Medicare authority to directly negotiate lower prices with drug manufacturers" -- have begun "campaigning on a promise to shrink or close the doughnut hole," the Times reports (Alonso-Zaldivar/Lin, Los Angeles Times, 7/2).