What's the Doughnut Hole?

2006-08-08T11:52:00.000-07:00

The Doughnut Hole The infamous Medicare Part D “doughnut hole“, or coverage gap, is looming for beneficiaries that are beginning to exceed their initial coverage. Kaiser Family Foundation estimates that nearly 7 million seniors will face the harsh reality of paying full-price for their prescriptions once they exceed $ 2,250 in retail drug costs. To reach the 95% catastrophic coverage, patients must pay over $ 3,600 in out-of-pocket expenses. And since most patients will not be spending through the doughnut hole they will be needlessly paying exorbitant prices for their medications.

Solution

In fact, many seniors are reporting that they will be forced to stop taking their medications during the gap which could have serious health consequences. Licensed Canadian pharmacies like XLPharmacy Canada are a welcome solution to that dilemma by offering savings of 40-80% on the very same medications.

Canada Alternatives

Shopping Canadian when you hit the doughnut hole may mean the difference between staying on your medications and not being able to afford them at all. Most patients are finding that paying full retail price for several months is senseless, if not impossible. Ordering from Canada, in that situation, is the perfect answer.

What’s the difference?

The bulk of Medicare beneficiaries will slide into the doughnut hole in the fall of 2006. However, the issue has already become a painful reality for some. Just four months into the program, Mildred Lindley has hit the point in her coverage where she has to pick up the full cost of the medication she takes to keep her bone marrow cancer in remission. As a result, her two-month supply of Thalomid shot up from $40 to a whopping $1,300.

“If I can’t get it, I guess I’m here until the Lord takes me out. That’s all I can do, because there’s no way I can afford it,” said Lindley, an 80-year-old from Jonesboro, Ark. “I’m in the hole all right.”

The Legalities (not)

Despite what political opponents of Canadian online pharmacies are saying, Canadian Pharmacies are open for business, have ample supply and our mail is getting through. You don’t need to suffer through the coverage gaps, the Canadian option is better than ever. US Senators in many states have legalized this option for their populace. The hype is in fact just that…hype.

Safety

XLPharmacy Canada has been safely dispensing medications to Canadian & U.S. residents for many years. All Canadian medications are Health Canada approved and are dispensed by licensed pharmacists.

Medicare - One Senior Woman tells it like it is

We’ve read about a lady who fell into the “doughnut hole” of the Medicare prescription drug program in late May, receiving just five months of insurance coverage from a plan she hoped would provide protection from huge medical costs throughout the year. This senior citizen now pays her prescription bill — about $700 a month for 16 medications — with her credit card.

She waits for the day when her Medicare coverage will kick in again, but that may not come until December — a 1-month reprieve before she starts the 12-month process all over again in January 2007.

In the meantime, she continues to pay monthly premiums for no coverage. So what does this senior think of the Medicare drug program that debuted Jan. 1 and was hailed by President Bush and Washington lawmakers? “Not a whole lot,” she survives on a $1,200 monthly Social Security check. “I wish it was like Canada’s system.

I’ve got relatives over there and their drugs are paid for.” The doughnut hole she is experiencing — and perhaps millions of elderly Americans will endure in the coming months — is a quirk in the Medicare program that had garnered limited attention.

So what’s the deal?

The provision requires a halt in coverage after a senior has received $2,100 in benefits. The Medicare coverage stops until the senior pays another $3,600 in out-of-pocket costs. At that point, they are deemed a “catastrophic” case and Medicare pays 95 percent of their drug costs for the rest of the year.

The gap in coverage was made as lawmakers designing the legislation struggled to hold down the costs of the massive new program. The benefits were limited to $2,100 but Congress also wanted to provide catastrophic coverage for those whose yearly drug costs reached several thousand dollars.

So, the doughnut hole was born.

One Medicare estimate had indicated that the average senior with high drug costs would fall into the gap somewhere in October. But at the Area Agency on Aging, which assisted thousands of area seniors during the hectic enrollment period, most are not surprised that some seniors are already seeing their benefits stop. Some will get out of the doughnut hole, some won’t.

The problem revolves around a yearly cycle, with benefits starting anew on Jan. 1. Seniors can switch to a different insurance plan in January, some that do not contain the so called ‘doughnut hole’. But, in exchange, the plans with no gap charge much higher premiums and require larger co-pays. And seniors are, logically, limited to those plans that cover all of their medications.
When seniors across the nation were signing up for the program, the confusion caused many to overlook the implications of the doughnut hole. Now, it is estimated that 7 million recipients will fall into the gap before the end of the year.

Some options for Seniors

-Ask for free drug samples from their doctor
-Seek out discounts at local pharmacies or on the Internet
-Some may want to get their drugs from Canada

And Medicare recipients are issued this caution: Canadian purchases do not count toward the $3,600 out-of-pocket spending requirement for those in the gap. Some low-income seniors may still be forced to choose between food and medicine, even though they’re paying into the Medicare program.

Those seniors who chose to see how the Medicare program really works and have not yet signed up may learn from the pitfalls suffered by others. Those who ignored the May 15 deadline will pay a penalty, but they may benefit from witnessing the shakeout in the first year.

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What's the Doughnut Hole?