This Donut Hole isn’t for Dunking
August 2006
This is the time of year many older adults are finding themselves with a donut hole, but it’s not the sweet kind you have with coffee. The new Medicare Part D prescription drug program has a so-called “donut hole,” gap in coverage that seniors hit after they’ve spent $2,250 on their drugs. Some seniors are shocked at the pharmacy to find out they have to pay the full drug bill instead of a co pay.
“Many older adults mistakenly think they’ll hit the donut hole after their out-of-pocket expenses hit $2,250. They actually hit that donut hole when the combined costs to them and insurance reach that amount,” said Jo Murphy, coordinator of the Michigan Medicare/Medicaid Assistance Program (MMAP) in West Michigan.
MMAP counselors throughout West Michigan have seen a number of older adults who are struggling with the gap in Medicare drug coverage.
“One lady is on a very expensive cancer drug. Her bill went from a co-pay of $25 a month to $300 for it, and she now can’t afford her medicine,” said Sue Wirth, MMAP Coordinator for Lake County. “We’re trying to work with her doctor to get free samples,” she added.
Older adults who do not have a plan with donut hole coverage will be paying 100% of their drug bill until their drug costs hit $5,100. After that, drug costs are consider catastrophic, and the Medicare plan will pay 95%. “My best advice to those who have hit the donut hole is to continue paying their bill. If they have extremely high monthly costs, it won’t be long before they reach the catastrophic coverage that has a very nominal co pay,” explained Murphy.
Those who have not yet spent $2,250 in drug costs this year can take steps to minimize the donut hole expense. “Now would be the time to talk to your physician about possibly switching to generics or another drug that might be less expensive,” said Murphy.
Open enrollment for Medicare Part D begins November 15. Those who are unhappy with the donut hole gap will have until December 31 to switch to a plan that does include donut hole coverage. New plans begin on January 1, 2007.
For questions on Medicare, call the Michigan Medicare/Medicaid Assistance Program at 1-800-803-7174 log on to www.mymmap.org. For information on senior services in general, call the Area Agency on Aging of Western Michigan at -888-456-5664.
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