Disability Issues

MIAMI – Lawmakers have wooed seniors skeptical of the health care overhaul by emphasizing the plan would close the “doughnut hole” — a gap in Medicare drug coverage that can cost thousands of dollars a year.

But getting support for the entire overhaul from this powerful voting bloc has been difficult, despite Democrats repeated town hall meetings, interviews and congressional hearings.

Medicare Part D established a new prescription drug benefit in 2006. The doughnut hole was designed to reduce the overall cost of the program. An estimated 3.4 million seniors fall into it each year.

Most people never see the other side of the doughnut hole. They simply wait for New Year’s Day. The House health care bill would close the gap gradually until it’s eliminated in 2022.

There are about 39 million people aged 65 and older in the U.S. and they voted at a higher rate than any other age group in the 2008 election, according to the Census Bureau. The 40-million-member AARP has endorsed the House’s version of the bill, but voters aren’t yet sold on the plan.

The latest Kaiser Health Tracking Poll, released last month, found just 32 percent of those 65 and older believed passage of a health bill would leave them and their families better off, compared with 44 percent of respondents under the age of 65.

When asked about elements of the health overhaul plan that are “extremely” or “very” important, the doughnut hole was the No. 3 issue for Republicans, and No. 4 for both Democrats and independents.

http://news.yahoo.com/s/ap/20091204/ap_on_he_me/
us_health_overhaul_prescription_drugs

Conclusions

The CMA revealed that a high percentage (90.3%) of beneficiaries
were not enrolled in the lowest-cost Medicare Part D
plan. This finding emphasizes the need for annual reevaluation of
Part D plan offerings by Medicare beneficiaries. Our study results
further indicate that Part D community outreach interventions
performed by trained student pharmacists can help Medicare
beneficiaries to navigate their Part D benefit effectively. In their
capacity as patient advocates, these trained pharmacy students
may have a pivotal role in reducing out-of-pocket costs for Part
D beneficiaries. Although the largest absolute potential cost
savings could be expected for those participants without a subsidized
benefit (non–dual-eligible and non-LIS beneficiaries),
those with a subsidized benefit can potentially realize a greater
percentage of cost savings.

http://www.ajmc.com/media/pdf/AJMC_09aug_Patel_545to553.pdf

Assets and Income Are Both Important in Subsidy Denials, and Access to State and Manufacturer Drug Programs Is Uneven
GAO-08-824 September 5, 2008

In 2006 and 2007, assets and income were both important factors in LIS denials, but income was of greater importance. In 2006, 4.5 million beneficiaries applied for the LIS and more than half were denied the subsidy. About half of LIS denials in 2006 were based solely or in part on applicants’ assets exceeding program thresholds, and in 2007, about 30 percent of LIS denials were for this reason. By contrast, 66.2 percent of denials were due at least in part to income in 2006 and 81.2 percent in 2007. Because some applicants in both years were denied the LIS by an initial screen that only asked about assets and were not required to give information on income, it is impossible to know the number of these applicants who would also have been denied the LIS because of their income. Among those who provided detailed information about their assets, applicants denied the LIS often exceeded the asset threshold by a relatively small amount, and in both years more than one-quarter of these applicants exceeded the threshold by less than $5,000. Some states and drug manufacturers offer programs that assist low-income Medicare beneficiaries in obtaining prescription drugs, but the availability of these programs and the assistance they offer are uneven. Twenty-three states offer State Pharmaceutical Assistance Programs (SPAP), which can supplement Part D benefits. These SPAPs differ in the type and extent of assistance they offer, but they generally cover some of the beneficiaries’ out-of-pocket prescription drug costs. Prescription drug manufacturers’ Patient Assistance Programs (PAP) also assist low-income individuals in obtaining prescription drugs. However, not all PAPs are open to Part D beneficiaries, and the drugs provided are limited to those of the sponsoring manufacturers. CMS concurred with our report. SSA expressed appreciation that we used its analysis of applicants denied the LIS in 2006 and 2007 as the foundation for our analysis of the impact of the assets test on LIS applicants.

http://www.gao.gov/products/GAO-08-824

Alliance for Retired Americans member Dolores talks about her paying for prescription drugs as a cancer survicor and the payments she has to make while in the Medicare Part D doughnut hole.

A video by FamiliesUSA about the Doughnut Hole in Medicare.