"As you wander throughout life, brother
Whatever be your goal,
Keep your eye upon the doughnut,
and not upon the hole."
(On wall mural in old Mayflower Hotel coffee shop in Washington DC)
This is probably good advice, but it really depends on the size of the hole that you, or people you care about, are about to fall into. An estimated 24-38% of enrollees in Medicare Part D are expected to hit the doughnut hole, where they have no coverage for prescription drugs, but do have to keep paying the insurance premiums. Many will hit this hole much earlier than they expected, because of an apparently little understood provision in the plan.
(More below the fold)
The shock of seniors who are already falling into the Medicare Part D(isaster)doughnut hole is discussed in an
AARP magazine article this month. And no, the irony of AARP identifying this as a problem after they lobbied heavily for Medicare Part D has not escaped me.
"It blew my mind," says Carolyn Taylor, a 66-year old retiree from Phoenix "I couldn't believe that in only four months I'd be in the doughnut hole." Early in May, her monthly out-of-pocket cost for her six drugs ballooned from $30 co-pays to paying full price--$99 for one drug, for example, $184 for another.
Taylor hadn't grasped that the $2,250 limit in the initial coverage period prior to the gap means total drug costs: what her plan had contributed as well as what she had paid. "I didn't understand that" she says." (In and out of the doughnut hole, Patricia Barry, AARP June 2006.)
BTW, the $2,250 she paid includes deductible and co-pays, but not insurance premiums, or any drugs she bought out of network, e.g., if they weren't on her formulary. And off formulary drugs, or drugs from foreign sources won't count towards the coverage gap total of $2,850.00 she will have to fork out until she hits the "catastrophic coverage" threshold: $3,795.00 this year (again, note this does not include premiums). So a lot of the seniors whom lying Leavitt said are saving money on this plan are waking up to find out it was much more expensive that they thought.
I thought I was a pretty good reader, but I didn't pick up on the point that the initial coverage ceiling represented the total cost of the drugs, not just the portion payed by the insured. Indeed, the AARP article indicates that many seniors did not understand how this provision worked. "She's not alone, "The coverage gap is a totally new phenomenon that you don't have in your auto, fire or home insurance, so it's one of the hardest features for people to comprehend," says Stephen Schondelmeyer, a drug benefit expert at the University of Minnesota. "It's like having flood insurance--but for the summer months, when you might need it, they don't cover it."" (Ibid.)
Try to imagine the impact of those kind of out-of-pocket expenses on someone living a marginal existence on a retirement income, or on Social Security. Especially now at a time when the cost of everything else, including essentials like food and heating oil, is markedly increasing. How many seniors will give up on the medications that are keeping them alive, especially if these are medications for high blood pressure, or other chronic diseases in which the damage from stopping may not be immediately obvious? How many of our mothers and fathers will fall into this hole and not come out alive on the other side?
But outrage alone, while cleansing, isn't going to help these folks. Channeling the outrage, both of the seniors and our own, into energy at the polls in November will indeed help us keep our "eye on the doughnut." This should be a good issue for our Democratic candidates,.and it is up to us to keep it in their sites. It's also a good issue to develop and discuss at your local nursing home, assisted living center, or active seniors development. Seniors vote; its high time more of them vote for Democrats.