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Yes, RAN OUT. Apparently, it's called a Donut Hole. We went to go get my mother's blood pressure medication filled and when we picked it up, I was told the "Co-pay" was $64.12. I'm like that's the CO PAY??? Well how much does the drug cost total? Oh it's $94. . I'm no mathematician, but I'm thinking that's not much of a savings considering my mother has worked full time for the state for the last 20 years and has earned her medicare coverage right? The Pharmacist went on to explain to us that we'd have to call the number on my mom's medicare card, but more than likely she's in the donut hole. She told us that lots of seniors face this every October or November when their medicare coverage runs out.
I called, and sure enough, the limit for prescription drug coverage is $2510.00 per year. Once that is used up (including what my mother paid as co-pays) she has to pay 100% out of pocket. I asked why she had run out, and you guessed it, Aricept is $171.00 a month, and the Seroquel is close to $300 a month. That's not including her other medications which she needs to live like blood pressure medication and her blood thinner medication.
I found these statistics while doing my search
Medicare Part D: You should know that…
* 7 million hit Medicare's Doughnut Hole trap in 2007. Did you?
* While in Medicare's Doughnut Hole you'll pay the full retail for drugs completely out-of-pocket.
* You must pay $3850 in order to pass Medicare's Doughnut Hole.
* Drug prices increased 9.2% from April 2006 to April 2007 on the top 15 drugs
* The average senior may fall into Medicare's Doughnut Hole on Sept 13nd in 2007.
* Medicare's Doughnut Hole will continue to grow and engulf more seniors each and every year.
* Millions will be unable to afford their life-saving meds once in Medicare's Gap, causing dire health consequences.
* Mortality rates amongst seniors increase 22% when Medicare Part D is cut off, such as in the case of Medicare's drug coverage gap.
* The pharmaceutical companies are reporting record profits since the start of Medicare's Part D Drug plan.
* Many call Medicare Doughnut Hole a “black hole” because once a person falls in, few get out.
How can our country, the 'greatest country in the world' have such a crappy system for our seniors who have worked their entire lives? What a mess.
What is my mom going to do? I don't know. She was extremely upset, and told me she wasn't going to take her Aricept or her blood pressure medication anymore. I told her she had to take those medications or she could die. She said she wasn't.
Here is another interesting little tid-bit about why we have this plan. Thank you once again George W. . .
The Expanding Doughnut Hole
By now most people have heard that the Part D benefit has a large gap in coverage that often hits people by surprise when they go to the pharmacy and discover they have to pay 100 percent of the cost of their drugs. During this gap, the insurance companies providing Part D still receive monthly checks from plan members and taxpayers, but those companies pay nothing toward covering the prescription drugs of people with Medicare.
Less well known is that the coverage gap is even wider next year. The Bush administration has bragged to the press that the average Part D premium is going down, but it failed to mention that all other out-of-pocket spending is going up. The amount people will have to spend out of pocket before their Part D coverage starts picking up the tab again will rise from $3,600 in 2006 to $3,850 in 2007 (see chart below to learn how the standard Part D benefit changes in 2007).
Worse, that money will buy fewer medicines in 2007 because Part D fails to rein in drug prices. An AARP study found that prices for the prescription drugs most commonly taken by older Americans rose over 6 percent, more than double the cost of living adjustment in Social Security benefits that kick in on January 1. Earlier research found that Part D plans pass on price hikes by pharmaceutical manufacturers nearly dollar for dollar to plan members.
The blame for both trends lies squarely with the Congressional leadership.
Congressional leaders forced through a drug benefit bill with a huge coverage gap. The law makes the gap grow as Part D spending per person grows. And, because Medicare is prohibited from negotiating drug prices, as manufacturers jack up prices, the coverage gap gets even bigger.
Instead of fixing these fundamental flaws with Part D, the Bush administration touts poll numbers that show how people “feel” about their Part D plan. But the same polls that show 80 percent satisfaction rates also reveal that 49 percent of those enrolled in Part D are paying the same amount, and 19 percent are paying more for their prescription drugs than they did before receiving coverage under Part D.
How can a program that will cost taxpayers and people with Medicare $1 trillion over the next 10 years do such a poor job of lowering the prescription drug bills of people with Medicare?
The answer is simple. Part D was designed to benefit the insurance companies that sell Part D plans and the pharmaceutical manufacturers that sell their overpriced medicines, not to be the best benefit possible for people with Medicare. Drugmakers and insurance companies are 100 percent satisfied with Part D because it has added millions to their bottom line.
By way of a thank you, the insurance companies and drugmakers have showered the Bush administration and Congressional leaders with massive campaign contributions. Some lawmakers and top administration officials have since been rewarded with lucrative jobs working for these companies, but others are up for re-election this November. That is when we have the chance to send them looking for employment in the private sector.
Source: http://seniorjournal.com/NEWS/MedicareDrugCards/6-09-22-MedicaresDoughnutHole.htm
