The Medicare “doughnut hole” is the name given to a situation where seniors suddenly find themselves without coverage for their medications. A study finds that when seniors reach this annual gap, they are most likely to stop taking their heart related medications.
There are four parts to Medicare. Part D is the one that provides coverage for prescription medications. Seniors who become eligible for Medicare are able to get Part A right away, and might also be able to sign up for Part B at that time. To get Part D, a senior has to seek out this sort of policy from a private health insurance company.
Medicare Part D provides coverage until the person hits what has been called the “doughnut hole”. It works like this. A senior pays out of pocket for his Part D premiums all year long. He pays 100% of the cost of his medications until he reaches the $310 deductible amount. After that, the senior pays 25% of the cost of his medications, and Part D pays for the rest.
Eventually, the total amount spent on medications, between what the senior pays, and what Part D pays, will reach $2,800. This is when the gap in coverage, or “doughnut hole”, appears. Once again, the senior becomes required to pay for the full cost of his medications. Part D pays zero until the out-of pocket spending reaches $4,550. This starts over again every year.
The Affordable Care Act has been making changes that will close the “doughnut hole”. It is a work in progress. A study was done by researchers from the Harvard Medical School, Boston’s Brigham and Women’s Hospital, and CVS Caremark. The researchers looked at over 100,000 Medicare patients who had heart conditions. All of these patients had Medicare prescription drug coverage in 2006 and 2007.
The researchers were interested in finding out what happens when these patients are temporarily required to cover 100% of the cost of their medications. This was compared to seniors who had continuous coverage for their medications.
It was believed, by some lawmakers, that by making seniors aware of the cost of their medications, (by forcing them to pay 100% of those costs), it would encourage the seniors to seek out less expensive medication alternatives. Instead, what really happens is that the seniors end up going without their medications until their coverage returns. Obviously, it isn’t advisable to suddenly stop taking a heart medication.
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