The Starks take prescription drugs worth $200 every month for several problems ranging from arthritis to emphysema and heart failure. So, Donna and Grover Stark enrolled// in Medicare Part D, the new federal prescription-drug plan, last December.
Since the Coventry AdvantraRx plan paid for most of their drugs, minus $20 copays, the Starks were ecstatic. Suddenly, one day the coverage stopped. Donna was told by a pharmacist that coverage would continue only after each of them had spent $3,600 on drugs. The Starks are in their 70s and retired.
"We started wondering what in the hell was going on," said the Starks' daughter, Cheri Brudevold, who cares for her parents. Initially, she suspected it to be a scam. But it was not.
The Starks had actually tumbled into a complicated technical gap called the "doughnut hole" — a gap specifically designed as part of the Part D program that compels Medicare patients to pay the whole amount of their drug costs for a period after they reach a certain spending threshold. More than 3 million Americans will be affected by this gap in 2006. The average senior’s drug purchase this year will reach the threshold next month. When this happens, many ignorant seniors will find it as troublesome as it was unexpected.
"I've never known insurance that has this hole in the middle," said Liz Mercer, a Part D expert with the Statewide Health Insurance Benefits Advisors (SHIBA) program at the state Insurance Commissioner's Office.
"It doesn't feel logical at all."
To provide affordable coverage for seniors with average drug expenses and to provide catastrophic coverage for people with huge drug bills were the 2 chief aims of the Congress that created Part D.
Medicare pays for two-thirds of the first $2,250 in purchases under the standard Part D plan.
After $5,100, it pays 95% of the drugs’ cost. But in between lies the --doughnut hole — $2,850 wide!! The seniors must pay that from thPage: 1 2 3 4 Related medicine news :1
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