Nbadan
07-31-2006, 03:15 PM
WP: Bills Soar As Many Hit Gap in Drug Plan
Medicare Provision Jolts Some Seniors
By Susan Levine
Washington Post Staff Writer
Sunday, July 30, 2006; Page C01
The calls are starting to come in from shocked or angry seniors. They have just learned that their Medicare drug plans are maxing out on early coverage and that they must now spend $2,850 from their own pockets before coverage will resume.
"I can't pay for my medications," one man told Howard Houghton of the Fairfax Area Agency on Aging the other day. "What do I do?"
Over the next five months, several million Americans with high medicine costs could find themselves in a similar bind. The gap in insurance, popularly called the doughnut hole, is an unusual provision in most of the private plans offered in Medicare's new Part D prescription drug program. Advocates for the elderly say it is misunderstood and problematic....
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The program was designed to give all participants a certain level of insurance and to protect elderly and disabled recipients with chronic or catastrophic illnesses from huge prescription expenses. To afford those two goals, Part D's designers built in an annual period during which individuals have to pay for medicines themselves.
Under a standard plan this first year, Medicare handles 75 percent of drug costs after a deductible until the bill reaches $2,250. It does not kick in again until those costs total $5,100. After that, prescriptions are almost completely paid for. The very poor can get special subsidies.
Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2006/07/29/AR2006072900800.html?nav=hcmodule)
Everyone thinks they can receive about $2,500 worth of drugs before the donut hole kicks in! WRONG! The donut hole starts when YOU AND YOUR INSURANCE CO. TOGETHER have spent $2,500.
So, if you are taking an expensive brand name drug the COST of the drug paid by the insurance co. PLUS what you pay count toward your $2,500. As an easy mathematical example...if you spend $100.00 a month for drugs...and the insurance company pays the drug co. $1,000 a month. You are running up a bill of $1,100 a month...so in 2 1/2 mos. you start the donut hole! It comes up quickly! Many people won't be able to afford to live...especially if they need Chemotherapy drugs or any of the newer expensive drugs.
Medicare Provision Jolts Some Seniors
By Susan Levine
Washington Post Staff Writer
Sunday, July 30, 2006; Page C01
The calls are starting to come in from shocked or angry seniors. They have just learned that their Medicare drug plans are maxing out on early coverage and that they must now spend $2,850 from their own pockets before coverage will resume.
"I can't pay for my medications," one man told Howard Houghton of the Fairfax Area Agency on Aging the other day. "What do I do?"
Over the next five months, several million Americans with high medicine costs could find themselves in a similar bind. The gap in insurance, popularly called the doughnut hole, is an unusual provision in most of the private plans offered in Medicare's new Part D prescription drug program. Advocates for the elderly say it is misunderstood and problematic....
***
The program was designed to give all participants a certain level of insurance and to protect elderly and disabled recipients with chronic or catastrophic illnesses from huge prescription expenses. To afford those two goals, Part D's designers built in an annual period during which individuals have to pay for medicines themselves.
Under a standard plan this first year, Medicare handles 75 percent of drug costs after a deductible until the bill reaches $2,250. It does not kick in again until those costs total $5,100. After that, prescriptions are almost completely paid for. The very poor can get special subsidies.
Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2006/07/29/AR2006072900800.html?nav=hcmodule)
Everyone thinks they can receive about $2,500 worth of drugs before the donut hole kicks in! WRONG! The donut hole starts when YOU AND YOUR INSURANCE CO. TOGETHER have spent $2,500.
So, if you are taking an expensive brand name drug the COST of the drug paid by the insurance co. PLUS what you pay count toward your $2,500. As an easy mathematical example...if you spend $100.00 a month for drugs...and the insurance company pays the drug co. $1,000 a month. You are running up a bill of $1,100 a month...so in 2 1/2 mos. you start the donut hole! It comes up quickly! Many people won't be able to afford to live...especially if they need Chemotherapy drugs or any of the newer expensive drugs.