50% Discount for the Part D Donut Hole

by Mary Jane Stern

Sometime over the weekend of June 18^th a proposal was presented to our Senators regarding Medicare Part D and the donut hole by PhRMA, the brand-name drug manufacturers’ lobbyist.

What they are proposing is to offer a discount to Medicare Part D participants when they reach the donut hole.  The discount is up to 50% off the retail price for the cost of the prescription, but the full amount will be applied to your total out-of-pocket costs until you reach the $4,350 (for 2009) you have to spend before you reach catastrophic coverage and then only pay 5% of the drug cost.

Increased Cost to Medicare Part D or Substantial Savings?

Many concerns are being voiced that the program could actually increase the cost of Part D coverage.  Now Senator Max Baucus, Chairman of the Senate Finance Committee, claims the program will “dramatically increase government savings.”

If the program does increase Part D Coverage, who do you think will end up paying for this?  My guess is anyone participating in Part D.

The problem is nobody seems to know how this is going to happen.  There has been nothing written and there is no health reform legislation.

What’s Your Senator Saying?  Here’s What My Senator is Saying

The other day I wrote to Senator Bill Nelson, my Senator from Florida, asking him to support a Public Health Plan and part of his response to me was, “I introduced the Medicare Prescription Drug Gap Reduction Act (S.266) to reduce the large gap known as the “doughnut hole” that occurs when Part D beneficiaries who have paid pay $2,700 in prescription expenses receive no further benefit until they have racked up a total of $4,350 in out-of-pocket expenses, despite the fact that they never stop paying premiums.”

He also went on to say, “Finally, we must ensure that there are enough health care providers in America and that they are adequately reimbursed by Medicare and Medicaid so they can continue providing care to those most in need. I introduced S. 973, the Resident Physician Shortage Reduction Act of 2007, to address this growing problem. This legislation would expand the number of Medicare-supported physician residency training positions, with an emphasis on funding new primary care residency slots. The number of physician residents eligible for reimbursement has not been altered to reflect changing demand since 1996. I have also fought consistently for fair Medicare reimbursement rates”

Has anything been done?   Answer:  No.

Did Senator Nelson answer my question on a Public Health Plan?  No.

Instead he wants an insurance exchange – not sure what that is!  If you know, let all of us know.

Don’t be shy about contacting your Senator to voice your concerns about Medicare.  They all have email addresses and all you have to do is Google them.
Let us know what you learn by leaving a comment below.