Quite often I'd come across the term 'Medicare Donut Hole'. Can any of you give me a small account on this?
Total Comments: 3
Posted: Mon Nov 29, 2010 02:50 pm Post Subject:
The "donut hole" is the problem created by Congress when it authorized the Medicare Part D Prescription Drug Plan. After a beneficiary reaches certain threshold of "True Out of Pocket" ("TrOOP") expense, they enter the "donut hole" in which 100% of the next couple of thousand dollars of prescription drug expense is 100% their out of pocket expense. Once that amount has been reached, then "catastrophic coverage" resumes and the beneficiary pays reduced amounts for covered drugs until December 31. On January 1, it all starts over again.
Persons who receive "extra help" with their Medicare Part D coverage are not subject to the donut hole.
For more information on this, and other Medicare topics, visit www.Medicare.gov (the official Medicare website) and download the 2011 "Medicare & You" booklet which has already been mailed to all current Medicare beneficiaries.
Posted: Wed Dec 01, 2010 07:59 am Post Subject:
It's a nice explanation from you, Max. It would also help if you could explain more about the extra help that you're talking about. The Medicare website is certainly a good resource to follow, but I see there's a possibility of a good discussion getting generated over here.
Posted: Wed Dec 01, 2010 05:13 pm Post Subject:
Seniors on Medicare with low incomes can apply for and be qualified for "extra help" in paying for their prescription drugs. They receive a waiver from the annual deductible, and an exemption from the donut hole, and also have somewhat smaller copays for each generic and formulary name brand medication.
I don't know exactly what the threshold is, but my Mom's only income now is from Social Security, something like $900 per month, so I know it's at least that much, probably more like $1100-$1200/month, and she has been getting "extra help" since the inception of Part D a few years ago.
The whole Part D "thing" is complex and confusing to most, including insurance agents, but there are a few privately operated websites that offer pretty good explanations. In an effort to save a few Democratic seats in Congress this past election, Obama tossed a one-time "rebate" to the seniors who found their way into the donut hole this year. Pure, shameless pandering for votes and nothing else -- and it failed to work.
For the most part, the seniors don't like Part D any more than those of us who can explain it to others. Many, like my Mom, were already receiving their medications at low or no cost because the drug manufacturers made agreements with a number of states to do that (and became preferred vendors for Medicaid pharmaceuticals in the exchange of favors), and now they complain about having to pay for what they used to get free.
Chalk Part D up to George W. Bush and the Republicans in 2003 when the legislation was passed, who, in the 2000 presidential election cycle, promised the old folks (together with ALL the other candidates for President who said the same mostly in Florida -- where they all spent 50% of their campaign time), "If I'm elected President, I'll make sure you get drugs." GW Bush, in one speech, promised "high quality drugs". (I guess that meant better than the ones he took in the 60s).
Mostly, Part D was reported to Congress in 2003 as going to cost some $325 Billion over ten years. After the vote was cast and the bill was signed by Bush, the HHS representative who gave the numbers to Congress went on NPR and claimed that he was told to give those low numbers to Congress, instead of the real numbers which were something like $625 Billion. Today, we know it's going to be closer to $1 Trillion -- just for the first ten years. Then the rest of us Baby Boomers will start taking our Part D meds and the number could easily double in the next ten years.
And Obama continues to insist that the PPACA will "lower" the cost of health care in America. The only way that will happen is if we shut down most of the health care system. And that's a distinct possibility under Obamacare.
The alternative is the bankruptcy of America -- which won't happen, they tell us, because the Treasury can print all the money the government needs.
At that point, toilet paper will be more valuable than US currency. Forget gold . . . stockpile toilet paper today while it's cheap! You can't wipe your butt with a gold bar. Charmin . . . that's my plan.
Posted: Mon Nov 29, 2010 02:50 pm Post Subject:
The "donut hole" is the problem created by Congress when it authorized the Medicare Part D Prescription Drug Plan. After a beneficiary reaches certain threshold of "True Out of Pocket" ("TrOOP") expense, they enter the "donut hole" in which 100% of the next couple of thousand dollars of prescription drug expense is 100% their out of pocket expense. Once that amount has been reached, then "catastrophic coverage" resumes and the beneficiary pays reduced amounts for covered drugs until December 31. On January 1, it all starts over again.
Persons who receive "extra help" with their Medicare Part D coverage are not subject to the donut hole.
For more information on this, and other Medicare topics, visit www.Medicare.gov (the official Medicare website) and download the 2011 "Medicare & You" booklet which has already been mailed to all current Medicare beneficiaries.
Posted: Wed Dec 01, 2010 07:59 am Post Subject:
It's a nice explanation from you, Max. It would also help if you could explain more about the extra help that you're talking about. The Medicare website is certainly a good resource to follow, but I see there's a possibility of a good discussion getting generated over here.
Posted: Wed Dec 01, 2010 05:13 pm Post Subject:
Seniors on Medicare with low incomes can apply for and be qualified for "extra help" in paying for their prescription drugs. They receive a waiver from the annual deductible, and an exemption from the donut hole, and also have somewhat smaller copays for each generic and formulary name brand medication.
I don't know exactly what the threshold is, but my Mom's only income now is from Social Security, something like $900 per month, so I know it's at least that much, probably more like $1100-$1200/month, and she has been getting "extra help" since the inception of Part D a few years ago.
The whole Part D "thing" is complex and confusing to most, including insurance agents, but there are a few privately operated websites that offer pretty good explanations. In an effort to save a few Democratic seats in Congress this past election, Obama tossed a one-time "rebate" to the seniors who found their way into the donut hole this year. Pure, shameless pandering for votes and nothing else -- and it failed to work.
For the most part, the seniors don't like Part D any more than those of us who can explain it to others. Many, like my Mom, were already receiving their medications at low or no cost because the drug manufacturers made agreements with a number of states to do that (and became preferred vendors for Medicaid pharmaceuticals in the exchange of favors), and now they complain about having to pay for what they used to get free.
Chalk Part D up to George W. Bush and the Republicans in 2003 when the legislation was passed, who, in the 2000 presidential election cycle, promised the old folks (together with ALL the other candidates for President who said the same mostly in Florida -- where they all spent 50% of their campaign time), "If I'm elected President, I'll make sure you get drugs." GW Bush, in one speech, promised "high quality drugs". (I guess that meant better than the ones he took in the 60s).
Mostly, Part D was reported to Congress in 2003 as going to cost some $325 Billion over ten years. After the vote was cast and the bill was signed by Bush, the HHS representative who gave the numbers to Congress went on NPR and claimed that he was told to give those low numbers to Congress, instead of the real numbers which were something like $625 Billion. Today, we know it's going to be closer to $1 Trillion -- just for the first ten years. Then the rest of us Baby Boomers will start taking our Part D meds and the number could easily double in the next ten years.
And Obama continues to insist that the PPACA will "lower" the cost of health care in America. The only way that will happen is if we shut down most of the health care system. And that's a distinct possibility under Obamacare.
The alternative is the bankruptcy of America -- which won't happen, they tell us, because the Treasury can print all the money the government needs.
At that point, toilet paper will be more valuable than US currency. Forget gold . . . stockpile toilet paper today while it's cheap! You can't wipe your butt with a gold bar. Charmin . . . that's my plan.
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