THE DONUT HOLE

THE DONUT HOLE

The Medicare Part D prescription drug benefit, which allows people over 65 years old (or disabled) to choose from a number of prescription drug plans, or PDP’s, has disillusioned many participants when they have abruptly gone from making co-payments for their medications to incurring 100% of the total expense.

This gap in coverage, dubbed the ‘donut hole’, has historically begun at the $2,830 rate of expenditures in Rx medications and persisted through the $4,550 mark when Medicare again pays most of the costs. Pursuant to the newly enacted Patient Protection and Affordable Care Act, and effective immediately, a Medicare recipient who hits the donut hole in 2010 will be provided a $250 rebate check. In 2011, beneficiaries in this gap can receive a 50% discount on brand name drugs and by 2020, the donut hole will be filled and coverage according to one’s PDP will pay as always. Additionally, Medicare recipients in 2011 will receive a free, annual wellness visit to their doctors and will have all out-of-pocket expenses waived for preventative care.

Many senior community centers offer help in deciphering PDP’s and offer advice on which plan is most apropos for your needs. The State Health Assurance Program, listed in your local directory, provides one-on-one assistance to Medicare recipients and the website MedicareSaver.org will show alternative money saving plans. Also, the non-profit Medicare Rights Center will help find a drug plan that is good for you and includes information about programs to help pay for your prescription drug costs.

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