HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Monday, September 25, 2006

Donuts: Not Just for Breakfast

More and more seniors are suddenly discovering the Medicare Part D Donut Hole, according to Ezra Klein, writing at Tapped, and the discovery is not pretty (and that is putting it very mildly).  He writes,

Millions of seniors are about to tumble into the donut hole, a coverage gap that extends (usually) from $2,250 to $3,600, at which point federal insurance kicks back in. Most seniors, as we already knew, were unaware of the gap. And this is what it looks like when they fall in it:

Frances Acanfora, 65, had been paying $58 for a three-month supply of her five medications. But this month the retired school lunchroom aide learned that her next bill would be $1,294. She had entered the doughnut hole.[...]

After talking to her doctor, Acanfora decided to temporarily stop taking a drug as part of her treatment for breast cancer. She hopes to obtain some free samples of eye drops for her glaucoma. Three other medicines -- for high cholesterol, diabetes and osteoporosis -- cost $506.62, which Acanfora put on her credit card.

"I pay a little bit at a time," she said. "What am I going to do? I need it. . . . Sometimes, just to think about it, I cry."

In case anyone's wondering about the staggeringly strange structure of it all -- don't. It makes no sense. The concept behind donut holes is that they ensure coverage for basic care, so folks don't skimp on preventive and diagnostic services, then impose a certain level of cost-sharing in order to incentivize all those magical things price-conscious consumers apparently do, then pick up the coverage again for those who are simply ill. It makes a certain amount of sense -- unless you're dealing with prescription medications for seniors.

Ezra has more to say about the subject and its impact on seniors who need their medication.  He further notes that this donut hole could be a big problem for politicians this Fall.

http://lawprofessors.typepad.com/healthlawprof_blog/2006/09/donuts_not_just.html

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