The euphoria over Medicare's Part D drug plan is slowly dying as the senior citizens are coming to realize that the plan has holes that could cost them a big bundle on medicines. The hole, called 'doughnut hole', requires them to spend about US$3,600 from their own pockets once their Medicare tab reached US$2,250.
For those under the Part D plan, Medicare shells out as much as US$1,500 for the first US$2,250 spent on medicines. In addition, if one spends over US$5,100, it covers 95 per cent of the cost above that. But the gap between US$2,250 and US$5,100 has to be covered by the unsuspecting senior citizens from the own pockets.
Most are unaware of the doughnut hole and some that are, aren't clear about how big the difference is. Contrary to popular belief that the hole ends at US$3,600, the amount is actually what the senior citizen is expected to pay from his or her own pocket before Medicare starts taking care of the expenses once again. There are plans that come without the doughnut hole but the premiums for those are higher. “I've never known insurance that has this hole in the middle. It doesn't feel logical at all,” said Liz Mercer, an expert from Washington's Statewide Health Insurance Benefits Advisors (SHIBA) of the Part D plan.
Not surprisingly, the loops of Part D have irked many senior citizens, one being 83-year-old Orlando resident Marion Porteus. “They raved about how wonderful this program was. I just think they keep dwindling away the help for people who need it,” she said, then added that she plans to take some help from her children to fund her health needs. “Fortunately for me, I have five good kids. I'm lucky, I have a pension,” Porteus said, but not without expressing her anger with the federal government's treatment of senior citizens.
Senator Bill Nelson, a Florida Democrat, has urged the Senate to do away with the doughnut hole, or at least minimize the gap. Other Democrats like House Minority leader Nancy Pelosi are also lobbying for the same. “We have, according to our staff in Orlando, a little over 300 complaints about the doughnut hole,” Nelson's spokesman Bryan Gulley said. Agreed Medicare Rights Center spokesperson Deane Beebe. “They (the complaints) are coming in and coming in quick. The problem is most people don't have US$3,600 on an annual basis. They are borrowing it. They are charging it or deleting meager savings and saying, 'What will they do next year?'” she said.
Which is just the question 88-year-old Ward Shaw wants an answer to. He and his wife are trying to find a way to find a solution to their health cost ills, made more complicated by the doughnut hole. “We're working toward it. We'll buy what we need for 60 days to take us until the first of the year,” Shaw said.
However, AARP spokesman Dave Braun has a different take. He said that about 90 per cent of the seniors who have enrolled for Part D will not fall into the doughnut hole this year. “There is no question this is complex and no question this gives people headaches, but this benefit didn't exist one and a half years ago,” Braun said, choosing to take a positive look at the developments.
Meanwhile, asked about the Democrats pushing for lower prescription drug costs and the utilization of the saved amounts for the doughnut hole, Centers for Medicare and Medicaid Services administrator Mark McClellan had this to say, “The drug plans are aggressively negotiating. UnitedHealthcare, Humana, and others collectively cover tens of millions of beneficiaries and they are using that negotiating clout to get prices down. That's one reason the costs have turned out to be so much lower than expected. Ninety per cent of seniors are enrolled in drug coverage and have the option of getting comprehensive coverage that fills in the doughnut hole.”
