Medicare Beneficiaries Reaching Coverage ‘Doughnut Hole’
Three newspapers on Sunday examined how some Medicare beneficiaries have reached the so-called "doughnut hole," or coverage gap in the Medicare prescription drug benefit. Under the doughnut hole, beneficiaries are responsible for 100% of drug costs between $2,250 and $5,100. Medicare covers 95% of prescription drug cost beyond $5,100 (California Healthline, 7/27).
Summaries of the articles appear below.
Baltimore Sun: Some experts say that many Medicare beneficiaries are unaware that the doughnut hole exists or that beneficiaries have "heard about the gap" but "don't understand how it's calculated and are surprised when it hits," the Sun reports. In addition, some beneficiaries might only keep track of their out-of-pocket drug costs, rather than their total drug costs -- a figure that is needed to determine when a beneficiary will reach the doughnut hole (Ambrose, Baltimore Sun, 7/30).
New York Times: The doughnut hole has been "upsetting many beneficiaries" and has "become a potent symbol as politicians debate the merits" of the Medicare drug benefit, the Times reports. The doughnut hole is "attracting fresh attention ... because many beneficiaries are just now discovering it," according to the Times. In addition, some beneficiaries mistakenly believed that the doughnut hole only affected drug costs from $2,250 to $3,600, figures that were "emphasized in brochures published by the government and insurance companies," according to the Times. The Times notes that the $3,600 figure only includes out-of-pocket spending, which "corresponds to about $5,100 in total drug spending." CMS Administrator Mark McClellan said beneficiaries will have saved $1,500 in prescription drug costs by the time they reach the coverage gap. He added that beneficiaries concerned about the doughnut hole can reduce their drug costs by switching to generic medications, using state assistance programs and switching to a new drug plan next year that includes some coverage during the doughnut hole (Pear, New York Times, 7/30).
- Washington Post: Some advocates for Medicare beneficiaries are expressing concern that the doughnut hole "is misunderstood and problematic," the Post reports. According to the Post, the "calls are starting to come in" to advocacy groups from beneficiaries who are "shocked and angry" upon reaching the coverage gap. In addition, some groups and health policy analysts "have warned of serious health consequences" for low- or moderate-income beneficiaries who exceed income requirements for assistance programs. According to some advocates, these beneficiaries could face "difficult choices" between buying "medicines or food and other necessities," the Post reports. McClellan said that for the majority of beneficiaries, the drug benefit brings "a peace of mind ... they never had before" (Levine, Washington Post, 7/30).
The complete transcript and audio in RealPlayer of the segment are available online.
In related Medicare news, the U.S. Chamber of Commerce has launched a national television and radio advertising campaign promoting lawmakers who voted for the 2003 Medicare law, the Dayton Daily News reports. The group is spending $10 million on the ads, which "than[k] lawmakers who backed the plan," according to the Daily News.
Bill Miller, political director of the U.S. Chamber of Commerce, said the campaign is aimed at assisting lawmakers who might encounter opposition for supporting the drug benefit.
For example, a 30-second ad airing in Ohio to support Sen. Mike DeWine (R-Ohio), states, "In Washington, a lot of people talk about improving health care for seniors. Mike DeWine is doing something about it" (Wehrman, Dayton Daily News, 7/28).