When you think of a doughnut, you think of something sweet!
But not if you're talking about Medicare in fact, the Medicare prescription drug program is bracing for what could be its most significant public relations hurdle yet.
In coming months, millions of older Americans and people with disabilities will face a lapse in coverage known as the "doughnut hole" when their annual drug spending hits and once $2,250. And once that happens it'll mean thousands of dollars in out of pocket expenses until the government jumps in to help pay for the prescription drugs.
Clara Reed exercised her options earlier this year for the new Medicare prescription drug plan.
She chose option "d" and now finds paying the bills could be a real stretch.
It's called a doughnut, or gap in the coverage. Once drug costs reach $2,250 for a patient, the senior must pay 100 percent for medicine until their total drug costs reach $5,100. That means seniors must pay the next $2,800 out of pocket. It's written in the Medicare handbook but was overlooked by most of the 22 million participants, until now.
50% of all patients who walk through the doors of Ebenezer’s medical outreach clinic are diabetic. The clinic just found out the makers of most of the diabetic drugs they pass out are cutting back!
The reason for the doughnut hole is simple. Controlling the program's cost expected to be about $700 billion in the first 10 years. It's goal is to provide a drug benefit to all 43 million Medicare beneficiaries. And make it market-driven so competition would drive prices down.
But the frustration is now. Some pharmaceutical companies have found a loop hole, in which has boosted profits.
But many health care experts say the whole plan is now nothing more than a catch-22.
A plan designed to save money, in the long run, but a plan that could cost a lot more if people who can't afford to take their meds.
If you fall into this category Medicare has two suggestions for seniors hoping to avoid the "doughnut hole".
Switch to lower-cost generics if possible and you won't hit the hole so fast.
This November, you can also switch plans! You may want to choose one that might be more expensive, on a month to monthly basis, but it offers coverage in the coverage gap.