Friday, August 13, 2010

Medicare Donut Hole: I'm Dealing with It Now

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Last week I found out I had entered the Medicare donut hole. I'm incredibly scared. I can't possibly afford to pay $350+ for my Imitrex. And that's generic. Where do they think people come up with that kind of money? I understand compromises had to be made to get the prescription benefit passed at all, but this is a huge problem for people like me. It's as if no one considered the somewhat low income elderly or disabled people who rely on Medicare for their health care. Obviously the poorest of the poor will likely qualify for Medicaid, but what about the rest of us in the middle class who are struggling to pay for all this?

In case you don't already know, the way this complicated situation works is that in addition to a deductible, Medicare beneficiaries pay 25% of their drug costs until they reach $2,830 of spending. At that point they must pay out of pocket until they reach $6,440 of spending. After passing $6,440 of prescription spending they pay only 5% of their costs until the end of the year. This compromise was intended to provide a moderate level of coverage for Medicare beneficiaries, then pick back up when they reach a catastrophic level of need. The big question is where people like me are supposed to come up with the $3,610 they will potentially need to spend because they are receiving no coverage for their medications.

Fortunately the health care reform legislation passed earlier this year will begin to close the so-called donut hole over the next few years.  Starting in 2011 Medicare beneficiaries will receive a 50% discount on name brand drugs and a 7% discount on generics. By 2020 they (we) will end up receiving a 75% discount on their prescription medications, which effectively eliminates the donut hole. It will be slow going getting to that point, but it's also important to remember that until the 2003 Medicare Modernization Act went into effect in 2006 there was no prescription coverage at all for Medicare recipients. I just don't know how I'm going to make it work this year. It's scary.

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DISCLAIMER: Nothing on this site constitutes medical or legal advice. I am a patient who is engaged and educated and enjoys sharing my experiences and news about migraines, pain and depression. Please consult your own health care providers for advice on your unique situation.