Seniors Falling Into Doughnut Hole Buy Fewer Drugs

About 12 percent of people receiving the Medicare prescription drug benefit in 2009 fell into the gap in coverage 鈥 the much maligned 鈥渄oughnut hole鈥澛犫 according to a .

Photo by Edward Kimber via Flicrk

While in the doughnut hole beneficiaries bought fewer drugs, including about 11 percent fewer monthly prescriptions in 2009, compared to when they’re still getting prescriptions subsidized, said the study by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation). Other studies a similar effect.

Excluding low-income Medicare enrollees who qualify for financial assistance and are not subject to the doughnut hole, there were聽19 percent聽of beneficiaries in the coverage gap in 2009, the study said. That percentage has been shrinking,聽most likely due to the increase in being offered, the study said.

The doughnut hole in 2009, the latest data in this study, started after the plan and the beneficiary paid a total of $2,700. Then, an聽individual聽was responsible for all of their medication costs until he or she had paid $4,350 in out-of-pocket costs.

After they come out of the “hole,”聽 Medicare picks up about 95 percent of the costs. Less than 3 percent of Medicare drug beneficiaries, excluding low-income beneficiaries, reach that catastrophic-coverage level, the study found.

This year, because of the federal health law,聽beneficiaries are getting a 50 percent discount off brand name drugs while in the doughnut hole. The benefit is important because few Medicare drug plans provide any gap coverage, and those who do charge much higher rates, according to .聽 This year, beneficiaries also get a 7 percent discount off generic drugs.

In 2012, the 50 percent brand discount remains and the generic drug聽discount doubles from 7 percent to 14 percent.

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