Sunday, March 31, 2019
The Medicare Part D donut hole closed this year (yay) and although it may be gone, it's not forgotten.
Due to federal legislation, the donut hole is closed for brand-name drugs in 2019. This closure means that [that a beneficiary] will be responsible for 25% of the cost of ... brand-name drugs in this coverage period. Although the donut hole for brand-name drugs has closed, [the beneficiary] may still see a difference in cost between the initial coverage period and the donut hole. For example, if a drug’s total cost is $100 and [the beneficiary] pay[s] [the] plan’s $20 copay during the initial coverage period, [the beneficiary] will be responsible for paying $25 (25% of $100) during the coverage gap. The donut hole will close for generic drugs in 2020, at which point [a beneficiary] will be responsible for 25% of the cost of ... generic drugs.
Kaiser Health News last week ran a story about the demise of the donut hole and the out of pocket costs beneficiaries still face. Doughnut Hole Is Gone, But Medicare’s Uncapped Drug Costs Still Bite Into Budgets focuses on the need for an annual cap on out of pocket drug spending by telling the stories of some of those who have significant out of pocket costs even with the elimination of the donut hole. "Legislative changes have gradually closed the doughnut hole so that, this year, beneficiaries no longer face a coverage gap. In a standard Medicare drug plan, beneficiaries pay 25 percent of the price of their brand-name drugs until they reach $5,100 in out-of-pocket costs. Once patients reach that threshold, the catastrophic portion of their coverage kicks in and their obligation drops to 5 percent. But it never disappears."
Although none of the Medicare programs have caps on spending, the article illustrates that those enrolled in original Medicare can purchase Medigap policies, which do not extend to Part D prescription drug plans. There's a great chart in the article that compares the existing Part D program with proposed legislation which illustrates the effect of the recent proposal to cap the annual amount.
Stay tuned and stay healthy.