KR: Millions face a `doughnut hole' lapse in Medicare coverage

How they think people will not get totally piss off when that hits, I haven't a clue.

every medicine we take is a preventative medicine to avoid higher costs of care if the disease is allowed to get out of control. If it is not controlled we face a lifetime with the effects of a stroke or heart attack, blindness, renal failure and/or amputation of limbs. The cost of the donut is catastrophic for the future.

I do not know how any man alive could have written a worse program. This alone shows their idiocy.

reason was that it was supported and pushed by bush. If he likes it, there is something dreadfully wrong with it.

until I started receiving small envelopes of info on Humana in the mail, unsolicited. When the 1st large packet arrived, I wrote: "Return to Sender" on the envelope and put it in the mail.

When the 2nd large packet (same as the 1st) arrived at week before the deadline, I did the same.


I stayed up until after 3 am on that night/morning in November 2003 watching the House "vote" on the bill. When it took three hours for the gavel to be brought down, I knew We, the People had gotten screwed.

I knew then what I know now. If the Decider wanted it, it was bad news.

I greatly hope this sinks the repuke party for a very long, long time.

my husband and I both have it. The Humana plan works just great for us. No extra monthly payment, generic drugs are always totally free - even in the doughnut hole. We pay $0 for primary care visits, and $5 (up from $0) for specialist visits. ER copay went up from $25 to $50, hospital charges went up a small amount, as did nursing home charges. Brand name drugs are $30 for preferred and $60 for nonpreferred (but luckily we don't need anything other than generic). I don't know how long this will be this good, but at least for now it's working great.

WARNING: I hope everyone knows that if you are in an HMO you have to take the HMO's prescription coverage. If you take someone else's the HMO will drop your medical coverage. This is not good, but at least, right now, for our Humana coverage, it is working out.

I agree with you that if the Decider wanted it, it couldn't be good, and I realize that for most people it is a nightmare, and my hubby and I are lucky right now.

We all know the only real solution for everyone is single-payer health care for all of us.

"to stud" (disability retirement). I'm happy with them. I could be happier, but nobody is going to insure me for free.

i'm covered with a much better plan under my wife's job. (i have medicare partB as secondary coverage).

"Furfaro, a disabled heart-transplant patient, found out that he'd hit the doughnut hole last month when he tried to fill a prescription for two immunosuppressant medications. Instead of two $25 co-pays, the pharmacist charged him $661 and $329 for the prescriptions.
"I threw a fit," he said. "What am I supposed to do? I don't have $661 in my pocket." Furfaro said he wasn't told about the doughnut hole when his Medicare HMO changed its coverage in January.

Furfaro, 47, left the pharmacy empty-handed, thinking that without his drugs he was going to die.
"I thought, `That's it. It's over.' The three years I put into the transplant, the waiting and everything. It was a waste of time because I can't get my medicine."

His father helped him purchase the cheaper drug of the two. But Furfaro has gone more than three weeks without the other drug, the one that helped him overcome severe organ rejection after the transplant in 2001. Disabled since 2001 and living off a monthly Social Security Disability Insurance payment of $1,171, he recently took a job as a security guard to earn money for his medications.

He's already feeling weaker and tired. "I lay around a lot. I don't have a lot of energy. I'm short of breath. I don't feel well at all," he said.
If his health deteriorates further, Furfaro said, he'll just get admitted to a hospital and receive his medicine that way, as Medicare will pay all bills if he's hospitalized."

not only his health but his SSD benefits and potentially his Medicare coverage.

The whole Part D is poorly written and thought out... except for the companies it benefits. :grr:

THEY CAN SIMPLY DIE.

Social Security would deduct the cost of his medications from his gross income in determining the effect of work on his disability status. It's called an Impairment Related Work Expense. Earning too much from working is still an issue..

is only the $1,171/month that is $14,052 which should qualify him for the low-income subsidy that cuts off at $14,246/year. I wonder if that income is his net social security and if they look at the gross amount that includes the payment for medicare to determine who gets help. I'm sure they checked to see if they qualified, not everyone was entered automatically.

I can't believe there is no help available, just insane. I should have read the article before I posted to see who they have checked with like their congress people, the American heart association, the red cross...
Or to see who paid for it before. So many people lost other programs that got them the drugs for reduced or no cost when this plan came in.

There are so many sins of this program besides the donut hole. People weren't allowed to buy supplemental insurance for the drug plan. (They actually said people abuse what they don't pay for. Ya, like this guy, abusively wanting to not reject his heart). If they had used the vast negotiating power of medicare the drugs would be much cheaper.
Even if he could get these from Canada much cheaper that cost would not count toward the donut hole. Until people spend the $3,000+ on approved drugs at approved stores they don't get out of the hole.

This donut hole will be bad for republicans, true. But that is little consolation considering how hard it will be for the people who need the medications.

I CAN'T STAND IT

...as a guy who works in a pharmacy, you'd think there'd be something the pharmacy could do to help him out until he could afford the meds! :(

I *think* there are some plans without the donut hole, but you have to pay more in premiums and copays too. Hmm.

To the poster who's dad is paying $33 a month, is that the cheapest plan available in his area? Humana basic here is only $13 a month, it's what we suggest to people like him who don't need the coverage NOW, but don't want the stupid penalty for not joining a plan...

it

"His father helped him purchase the cheaper drug of the two. But Furfaro has gone more than three weeks without the other drug, the one that helped him overcome severe organ rejection after the transplant in 2001. Disabled since 2001 and living off a monthly Social Security Disability Insurance payment of $1,171, he recently took a job as a security guard to earn money for his medications."

My income from SSD is more than his. If he also has less than $10,000 in countable assests he qualifies for low income support (there are 3 tiers). I am in the 3rd tier (almost have too much income) Smaller deductible, smaller co-pays, no dounghnut hole then on the regular medicare. The other two tiers are for those with less income and provide for less income. I'm paying on average about $5 permonth for four presecriptions that cost me $40 a month on the previous HMO plan for medicare recipients. Even without the tier system the coverage is better than before since there is no premium now associated with the HMO (Kaiser Permanente). He should have automatically recieved a packet from SSA because of his income that he would have filled out sent back to SSA. His HMO should then have followed up with the in fo on his LOS status. That's the way it worked for me and others I know. It was never a problem of not getting the info from SSA or my HMO - always the problem of getting to much info and feeling overwhelmed.

Working can also have a drastic efect on his SSD. Something isn't right about this story. He should contact his HMO and ask about the LOS qualifications. Doesn't make sense. He should really be beating on his HMO.

T

I know what the parameters are, and that the subscriber isn't covered until their out of pocket expenses reach the $3,500, and that they still have to continue to pay their monthly premiums along with all their med expenses. What I haven't heard is...what happens if they can't afford both? Lets say the patient opts to buy their meds instead of paying the premium. The insureance lapses, and I understand that. What then? Can the ever join the program again? If they can, are their premiums penalized for late enrolement? Do they have to start over again and face the doughnut hole AGAIN?

I don't think I've ever even heard the questions let alone any answers!

1) if they drop coverage, they will never reap the real benefits of the plan -- the catastrophic coverage that kicks in at the end of the donut hole and covers 95% of all prescription costs.

2) If they drop coverage, there will be a penalty, and they may be subject to a pre-existing rider (not sure on this one) for 1 yr after re-initiating it.

3) This plan is still better for the vast majority of people than what they had before (no coverage). Only about 1/3 of americans on Medicare had rx coverage previous to the plan. Many of those had Medicaid coverage which had signficant restrictions in many states. For those who meet the income guidelines, there is no donut hole, and no premium.

about this being better for the vast majority.

Those who had medicaid might be better off in some states, don't know. But Families USA (a nonpartisan health care advocacy group)is finding that the those once covered by Medicaid, are worse off under the new drug plan.

There are a few issues. One is that the copay is higher now (even though it is lower for them than others in the plan). If your income is low enough for Medicaid and you take several prescriptions that can be very hard to afford. Another problem is they were automatically put into plans and often found their drugs weren't covered. They could switch plans, as confusing as that is, but the formularies are often more restrictive than Medicaid and drugs can be dropped.
The biggest rip off in the transfer from Medicaid is that taxpayers are being robbed.While they didn't allow negotiating for lower prices in Medicare they DO in Medicaid, which the government pays for. So now we pay the premium and the much higher drug cost.

The assistance is not available to those with an income of about 14.5K a year or more. These people often got help from drug company, local or other programs for people without prescription coverage. These were free or reduced price. Once they could get Plan D they were dropped for the programs. So people with incomes from 14 to 22 thousand (about where the programs cut off) lost that aid and are MUCH worse off if they take enough or expensive drugs.
If you get $1,500 a month income you do not have 800 per month to spend when you hit the donut hole, you just don't.

Wealthy people who had no prescription coverage are better off or moderate income people with low drug costs.
Insurance and drug companies are MUCH better off.
Taxpayers are much worse off.

Medicare was supposed to cover me. Medicare/SSA/SSI did not agree so I was without medical coverage of any kind. Finally they found out that I WAS eligible for Medicare but I had to sign up for the Drug program. Humana was selected but then I found out that I would still owe about $100.00 every time I got my prescriptions filled. No one told me about the extra help program for persons under the $14,000 level. I quit taking my diabetes medication and asked the doctor for help. He is giving me samples for one drug and told me which were the cheapest so I could take the high blood pressure med and the one protecting my kidneys. I have been without some of my medications for a month. Medicare still has not finished with my application for extra help so God alone knows how long it will be.

The idiots who wrote this bill should have required the states to continue to assist Medicaid patients until the entire application process to transfer to Medicare Part D was finished. The should have been no gape between services and there should be no donut at the end of each year.

there should be NO gap. Under treated diabetes can have heavy implications and I hear rumors that kidneys and blood pressure matter to.

Way too many people went through the trouble you did and it's a crime. I'd be much more impressed if the congress had to take for themselves whatever plan they approved. Let's see if there big gaps in coverage then.

Hope it works out for you quickly and I am glad the doctor is helping now. What if he couldn't, that would be hell.
Since you should have coverage soon you might check with the red cross. They use to cover temporary emergencies for a month or two. Try that if you are going without some that could worsen your health. That's why we donate!

need coverage from this fiasco of a plan.

What a damned joke Bush played on the seniors.

Why didn't they just allow Medicare recipients go to their regular pharmacy and get all their medications at 1/2 price.Simple,easy,and a lot of money saved.

And the signing date,which was last Monday--what's with that? If you sign up after that date there is a penalty.

The "doughnut hole" thing is so ridiculous I can't discuss it rationally.

dropped the plan and told everyone to shift to one of the Medicare plans. You're lucky.

But, at the age of 65, he must pay $33.00 a month under W's plan. He's mad as hell.

Although we found a super basic plan for about $10. a month each we still chose not to sign up. It may npt be a lot of money to many but we need that extra $20. a month to just get by especially with the prices of food, gas and heating fuel going so wild and our income fixed until hopefully the congress gives us a decent COLA which would start NEXT January (and partly be taken away probably by the Medicare Part B increase... as usual. Hmm.. how much will each of these plans increase every year and further erode the aleady low income of people that need it so deparately and have no other alternatives?

The elderly will be dying on the streets because they cannot afford the basics. Welcome to W's America. We will have become a third world country but the GOP will brag about cutting taxes for the rich. That is our future.

you're being very optimistic.

and I signed up at the last minute. It won't help me but here is what bothered me. I was thinking what if they found some medicine to "cure" my disorder in 5 years and it really cost a lot and I'd have that huge penalty for the rest of my life.

Now they've been saying a cure for MS is "just around the corner" since I was first diagnosed over 20 years ago and they'll probably still be saying it 20 years from now. I also think they'll get the penalty dropped, but I really felt bullied into it.

I hear you about "the cure" carrot but it keeps the donations coming in and hopefully they'll eventually come up with something that really does CURE it (quite frankly I don't think a real "cure" will be a long time med but rather a short term treatment and the question then will be will the treatment be worse then the disease).

Although I agree (and hope we're right) that they'll remove the penalty, two other potential problems that may (or will) crop up if there's a decent treatment found, will be the "doughnut hole" gap and that any pham plan you have chosen may decide not to cover it at any point in time.

Unfortunately for the big pharm companies :sarcasm: I've long tended to be very skeptical of the medical field. Being a now long time x-nurse who's been into alt modalities for a couple of decades has just made it "worse" as has observing a "few" FDA/Phamr company screw ups and losing a friend and fellow MSer to a nasty but relatively unknown side effect (suicidal depression) of one of the early MS "miracle drugs". A long time ago I told my neurologist that I refuse to be a pharm companies guinie pig as long as I remain overall basically stable and luckily I have and w/o taking any Rx drugs for it. (After the first in the hospital "what the heck hit me" stay I learned I am highly over sensitive and very close to being like Linda Blair in The Exorcist on steriods so won't take them).

... and now I'm off to get more coffee and hopefully wake up a bit more. :hangover:
:)

Does that mean that when I am old enough to qualify for Medicare, I'll have to pay $33?

Silly. Stupid.

my annual prescription drug bill, which now is just about $200; premiums, copayments, radically increased drug prices and a $250 deductible will make the difference. Worse and to my endless fury, every added penny goes straight into (A) the drug lords' bank accounts and (B) from there into Republican campaign funds, with the annual cost soaring to about $600 for the very same drugs I take now for $200. And I belong to a nonprofit HMO, one of the very best (if not THE best) in the country -- a plan that routinely negotiated the lowest possible prescription drug prices, often as much as 300 percent below standard retail. But the Drug Lord Benefit bans all such negotiation -- which means that atop everything else, my prescription costs will go up up up too: all to put money in the bank accounts of the already-obscenely-rich fat cats.

_________
Edit: structure.

I studied the information online and was actually shocked by that "donut hole" thing. All of a sudden I woulda had over $700 a month in medications for the ones they cover after the donut hole, plus some others.

They describe or label the amount beyond the donut as "catastrophic." Brilliant.

We'll see how mine turns out, but I did manage to sign on to one that is constant.

I'm on disability.

is becoming true.

seen anything so damn scarey ugly? What did he do?....scare everyone who worked into making him CEO?

Now that he's retired....maybe he could go work as Monster in some kind of low-budget sci-fi movie.

He practically looks non-human. They haven't done that yet??????? Have they?

Karma... wait till the seniors get aload of the screwing they got...

Raping the old to give to the rich...

than making a profit on the health of others. Making an obscene profit, under the fiat of "law", is beyond any rational moral discussion. My thinking is that those running this country, and their supporters, represent the dark side, evil if you will. Taking from the sick and giving to the rich. It just defies explanation except for that it's evil run amuck. My heart hurts for those of us subjected to this unfair arrangement. You can just bet that Congress people get their heart meds just fine. Or in Kennedy's case head meds. Surely we as a humankind must find a better way to deal with health for all. Just as surely any country whose base is supposedly "christian" would be far more concerned than we are for the health of any and all human beings. Jesus said that love of money is the root of all evil. It hurts to see that in action in our government.

I know that what we are seeing in this drug plan reflects a form of avarice that runs through
Western history (I have to catch up on my Eastern history some day) like a red thread.
Asking those who are privileged to recognize those who are not seems to be a futile
tactic. It's why unions and populism exist or used to.

Your reference to the gospels reminds me of another mystery in my mind. What is this
'christianity' we honor every sunday that seems to me to to be distancing itself
from the simple gospels and focusing on the hell and brimstone, the fear? No
presumption made about anyones particular church it's just my observation that
when we are involved in war and other such 'evils' we pretend the gospels don't exist.

here in Houston they've canned the fire & brimstone, and focused on Abundance-type-mall-motivated-feelygoodystyle Christianity (Jesus soooooooooo wants you to have that bran'new custom H2, and IF he FAVORS y'all, you will git it. YEE HA!

Our neighbors are real Christian conservative blue collar folks who created a 'Christ died for your sins' birthday cake for their 5 y/o last month. They don't have time for any of that
Global Warming nonsense and just over extended themselves on a brand new SUV of some sort. They are moving soon and I have to say I will miss their endlessly entertaining comments on the world as they see it.

that REALLY sucks.

We are being robbed and beaten by our
government and the corporations it
now serves.

Incredible.

The way this law is written, when you are in the hole, you have to pay 100%

AND

NO SUPPLEMENTAL PLAN CAN REIMBURSE YOU FOR ANY CHARGES!

This is insane.

a different frame.

This is not Medicare. It's a privatized prescription plan. Insurance companies are who are benefitting. We need to construct another meme.

where the beneficiary enters catastrophic stage and medicare picks up 95% of your drug costs for the remainder of the year. i passed that threshold in january, and now i don't pay any co-pays for the rest of the year.

Or were never disabled and have retirement income so you can pay the gap. The disabled are the ones who are going to be hit the hardest. No medicaid to fall back on, but if they go to work to pay the gap and make too much, they're kicked off disability altogether.

Out of desperation, disabled will work to pay the gap and thus get kicked off of disability althogether, "proving" that the disabled was able to work in the first place and shouldn't be on the roles (this being the Republithug thinking, not mine), and thereby reducing the need for redistribution of income from the fortunate to the unlucky. The "why do I gotta' pay?" crowd engineered this.

BTW, those that can't "get a job" to pay their way through the donut hole and just die, well, that accomplishes the cold-hearted objective too. Kissinger once purportedly called south asians, "useless eaters" -- that about sums up the compassion the typical Republithug has for the less fortunate.

In addition to this Malthusian goal, Bush's base, the pharma and insurance pigs at the trough, have been lined up for a good feed.

It's disgusting and exceedingly cold. Welcome to Bush's Amerika. :(

BTW/The retail costs for medicine in my household are about $2,500 per month. Just one of my daughter's drugs account for about $1,800, and she'll be taking that for life. I have good coverage at work so I only spend around $450 out of pocket (nothing to sneeze at, of course), but I fear what kind of safety net will be available for my daughter when she leaves the nest (she's 14 now).

I have no idea if it will affect Hubby (diabetes, dialysis, SSD/Medicare/Medicaid). All I know is that once Medi-Cal switched us to the Part D plan, we got hit for a "deductable" for one of his meds. Now I have to fax copies of the official paper from Medicare to the Rx company and the insurance company. It says right on the sheet that he has no monthly fee and no deductable, only payments of $1 or $3 for meds.

And yes, it is costing us more than under Medi-Cal. There were no co-pays with the state program.

This would be an excellent plank for the Democrats to run on. This plan has cost the Repuglicans dearly among the seniors, and the Dems could get them all by pushing to roll the drug coverage into medicare as an included benefit, instead of a private enterprise plan as it is now.

This would have several benefits. First, by allowing the government to negotiats with the drug makers for all the government drug needs, like the VA does right now, costs would plummet. We are the only major country in the world that does not do this.

Example: A brand name drug that costs $100 a month at an American retail pharmacy costs on average $50 a month in Canada. Since we have a multiple of the population that Canada does, economy of scale would apply and the same drug would likely cost $25 or so here if we negotiated costs.

Now, if we took the average of the private drug insurance plans and used it as a true medicare drug premium, it's likely that we'd have the same kind of drug coverage the VA has, that is, $1 and $5 drug costs for everyone. And it would cost taxpayers FAR less than the gift we gave to the drug and insurance companies than does Part D now.

Of course, that makes far to much sence for Washington to adopt.

shop around and get the best price out there for their drugs? All those lazy elderly people will just keep buying the expensive stuff as long as someone else is paying for it. They wouldn't need the drugs anyways if someone else didn't pay for them to go to the doctor. People don't really get sick anyways. They just go to the doctor for fun as long as someone else is paying. "

I'll stop channeling Bush now. It makes my brain hurt and I'm out of (store brand) Motrin!

"I'm George Dubya Bush and I approved this message"! Hearing him say that used to hurt my ears.

for this unspeakably outrageous scheme by which the Bush Regime -- as always -- is robbing and killing the rest of us to help the rich get richer.

Once again, Bush has succeeded in turning a vitally needed social service into nothing more than a profit center for the wealthiest Americans: this while it is literally murdering the rest of us, merely so the Prescription Drug Lords can make even more obscene profits off our misery.

And "murdering" is not hyperbole: advocates for elderly and disabled people have been pointing out these problems since before the program became law, and they were jeered at, shouted down, ignored and in some instances methodically silenced. So the Bush Regime and its supporters -- yes many DLC "Democrats" voted for the law -- cannot claim they didn't know this measure would literally kill people.

Here's the original vote on the Medicare Prescription Drug Lord Benefit:

http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=108&session=1&vote=00262

Some Democrats later reversed their votes, but that was only sleight-of-hand. The damage had been done: the initial vote paid off prescription-drug-industry supporters and guaranteed the Drug Lord Benefit would become law.

_________
Edit: better head.

with medicare D, you pay $2250 as co-pay out-of-pocket....then you pay 100% of drug costs until your total out-of-pocket ANNUAL drug costs are $3600, ie you pay an additional $1350 out-of-pocket drug costs......once your ANNUAL out-of-pocket costs total $3600 (NOT $5850 in the article), then your co-pays are very low

I asked and asked (the person with the plan I went with) how this donut hole could be justified; ie this is supposed to SAVE seniors $$$, right?? (or so I thought was the argument when this was being pushed 'govt will now help seniors pay for medicines').........repeatedly got the argument that before this, 85% of seniors on medicare paid 100% for all medicine

this donut hole just seems 'cruel and unnecessary punishment'; there seems to be no real reason for this except to confuse people and make life very difficult for many

told otherwise, you were lied to by your insurance seller -- which, in the case of for-profits, happens constantly.

(I write analysis for an advocacy journal that serves elderly and disabled people; sorry it took me so long to return to this thread.)

(Vitamins and Herbs) in addition to Pharmaceutical Drugs. Many supplements really control and actually IMPROVE many illness symptoms, WITHOUT the litany of serious side-effects traditional Drugs have...which often worsen the person's condition, and also cause NEW health problems in addition.

I agree there should be no 'doughnut holes' in drug coverage, but the first $2K+ annually SHOULD cover the basic DRUG needs of MOST elderly/disabled Americans (except perhaps those hospitalized). Anyone taking more than 3 drugs at once, tend to become rendered in most cases house-bound due to dizziness, drowsiness and incapacitation from such a "cocktails" of drugs. In order to live a longer life, the older one gets, the more active one constantly must make an effort to attain.