Newspapers examine Medicare beneficiaries' experiences
with gap in Medicare drug coverage
[Jul
31, 2006]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 (Kaiser
Daily Health Policy Report, 7/27). Summaries of
the articles appear below. Click on the name of the newspaper to go
to the article:
-
Baltimore
Sun: Some experts say many Medicare
beneficiaries are unaware that the doughnut hole exists or
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. Tricia Neuman, a
Kaiser Family
Foundation vice president and director of the
foundation's Medicare Policy Project, said, "Unless they have
been keeping careful tabs on what their total drug expenditures
have been so far in the year, they probably will have sticker
shock when they go to the pharmacy" (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).
APM's "Marketplace
Money" on Friday reported on the coverage gap. The
segment includes comments from Robert Hayes, president of the
Medicare Rights
Center; Charlotte Yeh, a Medicare administrator; a
Medicare beneficiary who is currently experiencing the coverage gap;
and a Medicare beneficiary who is purchasing prescription drugs from
Canada to prolong the time period before she enters the coverage gap
(Palmer, "Marketplace Money," APM, 7/28).
Now,
keep up to date with daily feeds of newly posted stories about America's
Seniors...click on the box to the left