Sometimes I Feel Like a Piece of Bologna

The Hole

This week we fell into the hole—the donut hole. We aren’t alone. Three million seniors are expected to fall with us, many this month. The donut hole is a formerly little-known gap in the new Medicare prescription drug plan. Under the plan, the government pays for the bulk of drug costs only until the beneficiary and the government together have spent $2,250 for the year. Then beneficiaries pay 100 percent of costs until they have spent a total of $3,600 of their own money. Only then does the federal government resume its participation, paying 95 percent of any additional expenses. This plan was discussed in a Washington Post article dated last week. The Post estimates that 3 million seniors will fall into the donut hole this year.

When the new Medicare Part D Plan went into effect, Dad was in the nursing home. The staff there tried to explain it, but they weren’t sure about the details. And frankly, it was way over my head—and I have a master’s degree in health care administration! Mom didn’t even try. Having no context to understand it, we signed up and prayed for the best. Dad’s prescription drug needs continued to increase and so did his costs. And then, last week when Mom picked up his meds, she was hit with a bill of several hundred dollars!

We’ve been trying to figure out what to do. There are a number of programs that have been developed to help seniors in the hole, but figuring them out is almost as confusing as understanding the Medicare plan. Some of the drug companies have plans to provide their meds at reduced costs, but it looks as if we’ll need to go to several companies. Medicare offers five suggestions for bridging the gap

I’d like to know who our lawmakers thought they were helping. These problems were anticipated when it was in the legislative stage, but no one listened. And now, I’m not the only one feeling smooshed.

Labels: donut hole, Medicare Part D