HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, November 18, 2008

Medicare Prescriptions and the Doughnut Hole

The Washington Post provides facts about Medicare Part D:

Stethescope5Facts about Medicare Part D prescription coverage:

- Under Medicare Part D, elderly and disabled Medicare benficiaries can enroll in a private drug plan that is largely subsidized by the federal government. Before the benefit began in 2006, that drug coverage was available only though private supplemental plans.

- Medicare Part D contains a gap in coverage often described as "the doughnut hole." Patients in the coverage gap have to pay full cost out of pocket for their drugs,

- Under 2008 Medicare rules, once the cost of a patient's prescriptions reaches $2,510, including the amount the patient pays and the amount his or her insurer pays, the patient is in the coverage gap and must cover the next $3,850 in spending on his or her own. After that point, Medicare coverage resumes.

-  In 2009, the coverage gap begins at $2,700 in spending. The gap ends after the member has spent $4,350.

- Health insurers that do significant amounts of Medicare Part D business include Cigna Corp., WellPoint Inc., Universal American Corp., WellCare Health Plans Inc. and Health Net Inc. Insurers compete for Medicare business in a bidding system, with those who offer prices below a government standard being chosen.

- Humana Inc. will no longer participate in Part D coverage after Jan. 1, 2009.

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