• Reader Question – What will reform do for the doughnut hole?

    A reader asks:

    I am 55, and disabled. Although I am eligible for Medicare (disabled for 24+ mth.), I chose to stay on my wife’s medical plan until I could take enough time to understand my options and costs. Today I received the information that although we pay >$7000 / year – JUST FOR MY PORTION OF HER PLAN! – it will still cost more than that amount for me to switch over to either a) Part”B” + Medigap + Part”D”, or b) Part”B” + Medicare Advantage.

    Why? Primarily, it is because of the quantity, and types, of medication that I take for my condition, (Diffuse Systemic Scleroderma). When my local senior assistance program plugged my info into thee Medicare calculator, it spit out that I will required to pay more than the $7000 – primarily because of the “doughnut hole”.

    My question is this – do any of the plans being discussed, by The House and/or Senate, address this issue?

    I wish everyone who says that a public plan or Medicare is “free” would read your question.

    First of all, let’s explain to everyone what the doughnut hole is:

    Medicare mavens and readers of a certain age will already be familiar with the hole — the gap in coverage that leaves beneficiaries on the hook for the cost of prescription drugs when the cost of their prescription drugs passes $2,700 in a year. Coverage kicks back in when a beneficiary’s annual drug cost passes $6,154 in a year, according to the WSJ’s story on the deal.

    So once you go over a certain amount (which isn’t hard) you have to shell out thousands of dollars before any coverage kicks back in.

    The good news is that reform (so far) does have provisions to close this up, at least a bit.  It was part of the big deal the White House made with pharma.  Until the bill is passed, we won’t know for sure, but I suspect things will get better in terms of your out-of-pocket costs for drugs.

    Share
    Comments closed