Health & Medical

Falling Down the Medicare Donut Hole? What Now?

HELP! I have reached the Medicare donut hole. My income is less than $13,500 and I would qualify for all kinds of help – except I have some meager savings. Why should I be penalized for being prudent enough to save a few thousand for my old age? (Thinking that Congress and the AARP would help me with my old age – 80 – was a fantasy.) This gift to Big Pharma is a bad joke on old folks. Can you help people like me? – Romaine Galey Hon, Boise, ID

In a word: Maybe.

Medicare Plan D Donut Hole

This is for the 4- to 7-million American seniors who are today face to face with Medicare Plan D’s diabolical donut hole.

You forked out the initial $265 deductible.

You’ve paid about 30 bucks a month premium.

And you’ve footed another $500 as your share of the next two grand.

Now the retail cost of your covered drugs has hit $2,400*.

Prepare to plunge into the dreaded Medicare Donut Hole!

And until your total out-of-pocket cost reaches $3,850, your Plan D insurance company pockets your premiums while giving you diddly in return.

What a deal, huh? Amazing what happens when the drug and insurance lobbyists combine their wicked talents to write a new Medicare Drug Bill.

Thanks, Congress and AARP. Now American seniors are literally dying for lack of cash for medicine.

While the Medicare drug plan is helpful to a great many indigent seniors, to most of us it is nothing but an insidious shell game, a roguery fated by law to allow only the drug and insurance industries to win.

So what to do?

In the “bad old days,” before the Bush Administration strong-armed fellow Republicans into passing this trillion-dollar, break-the-back-of-Medicare boondoggle, drug companies’ Patient Assistance Programs (PAPs) helped bridge the gap between strapped Medicaid recipients and those able to pay their way at the drug counter.

With the advent of Plan D, the administration told pharmaceutical manufacturers that it was illegal to provide affordable drugs through PAPs to anyone eligible for the new program. Only later has Bush somewhat reversed that, saying it was all a bit of a misunderstanding.

Problem is, many PAPs created to help those with annual incomes of up to $40,000 were scared off. So for seniors now caught in the donut hole squeeze, there seems no place to turn.

Meanwhile, since Congress forbids the federal government from negotiating directly with drug manufacturers to obtain lower prices, drug prices soar**.

World Free Market to the Rescue

The good news: In spite of the US dollar falling to almost par with the Canadian dollar, drug prices at Canadian pharmacies are still far cheaper than you must pay through Plan D.

Prescription Drug Cost Cartoon: Medicare Donut HoleJust last year, a Congressional minority report concluded that prices offered by Part D drug plans are “over 60 percent higher than the prices available to consumers in Canada almost 3 percent higher than the prices [commonly] available at Costco.”

Faced with the prospect of coughing up the $3,000 or so to pay no-coverage premiums plus super-sized drug prices, here are your choices:

  1. Grin a bear it.
  2. Start buying your drugs at Costco. Avoiding your insurance company’s prices will almost surely save you money. And, according to AARP, as long as the drugs are covered by your plan’s formulary and you buy in the US, your receipts count toward the limit.
  3. Quit your Plan D insurance immediately upon reaching the donut hole. This allows you to put your premium money toward the purchase of needed medicine. Then buy your medicine abroad and watch your dollars stretch by up to 60 percent or more. For many, this makes the difference between staying on medications and not being able to afford them at all.

The downside to quitting…

  • If you spend over $3,050 on drugs before year’s end, Plan D won’t kick in again, this time to pay 95 percent. Chances are, if you are just now getting to the donut hole, this won’t happen. But it’s a gamble.
  • Unless Congress eliminates penalties for late joiners, if you want back in you must pay a 1 percent a month addition to your premium until you again join the program. Say you’re paying $30/mo. in premiums. If you stopped paying September 1st, you’d save $120 but have to pay an additional two bucks a month when you rejoin next January, possibly more if you returned to the same plan.

Never Give Up CartoonSo there you have it. Your government and mine have us between a rock and a sick place.

Oh, there is one more action you can take.

Write, e-mail or call your Representative and senators asking them to support HR 3162 which strengthens Medicare and HR 676, the Conyers-Kucinich bill that covers all healthcare needs, including dental care, mental health care, vision care, prescription drugs, and long-term care – at no extra cost!

Just like all other industrialized nations!

Meanwhile, good luck in today’s health-care crapshoot.

*This does not include medicine, not on your insurance company’s list of approved drugs, which can change at any time.

** The Veterans Administration, which is allowed to negotiate prices with the drug companies, pays 58 percent less than Medicare, on average.


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