Bill Would Require Monitoring of Drug Benefit Gaps
MEDICARE
The Eagle-Tribune
Bryan McGonigle
Boston University Washington News Service
Sept. 27
WASHINGTON, Sept. 27 – Sens. Edward Kennedy, D-Mass., and Robert Menendez, D-N.J., introduced legislation Wednesday aimed at monitoring benefit gaps in the Medicare Part D prescription drug coverage.
The Honest Medicare Act would require the Department of Health and Human Services to provide a monthly report on the number of seniors who have fallen into what is known as a “doughnut hole.”
Under the Medicare Modernization Act that Congress passed in 2003, most drug insurance plans require that after total prescription drug costs have reached $2,250, a beneficiary must pay 100 percent of prescription costs for the next $2,850. During that gap in coverage—nicknamed the doughnut hole—seniors still must pay monthly premiums.
“The first step toward finding a realistic solution is to honestly define the problem,” Kennedy said in a statement after introducing the bill. “Our bill requires the [Bush] administration to level with the American people on how many seniors are losing coverage for the drugs they need to protect their health.”
Kennedy’s bill also would require the department to report how much money people are spending on prescriptions while in that hole.
The Congressional Budget Office issued a report last year detailing the extent of doughnut holes in the Medicare Part D plan, saying that “roughly one-third of Part D enrollees will have drug spending that exceeds the standard benefit’s initial coverage range in any given year.”
In Massachusetts, there are 44 health care plans from which to choose. Only one plan is full-coverage, and the rest have doughnut holes.
Last week, House Democrats from the Ways and Means Committee issued a report finding that 88 percent of beneficiaries nationwide who don’t receive extra help are enrolled in plans with substantial coverage gaps.
“Without a change in this misguided plan, the doughnut hole will be an annual problem that only gets worse,” Rep. Marty Meehan, D-Mass., said after the report was released. “In 10 years, the doughnut hole will have more than doubled, and drug costs will still be high because the government is prohibited from negotiating for lower prices.”
The report also said that premiums for plans with full coverage cost on average two and half times more than those with doughnut holes.
Residents in Massachusetts pay an average annual premium of $400 more for full-coverage than for a low-cost plan with a doughnut hole.
Janice Boyd is community educator for Elder Services of the Merrimack Valley in Massachusetts and a counselor with Serving Health Insurance Needs of Elders, or SHINE – an advocacy group that guides seniors through the health-care decision process. She said that while doughnut holes have been a big problem nationwide and can be a problem in the commonwealth, her organization has seen fewer instances of problems than expected because Massachusetts offers Prescription Advantage – a state-sponsored prescription plan.
Prescription Advantage allows its members who are on Medicare to buy a wide range of prescription drugs and helps pay Medicare Part D prescription costs, lowering the cost to patients and lessening both the likelihood and the effect of a doughnut hole.
“There are people that actually have both a Medicare D plan and Prescription Advantage because of their understanding of how the two work in conjunction with each other,” Boyd said.
Education has proven to be a big challenge to senior health care in Massachusetts, Boyd said, which is why groups like SHINE are helpful.
“We worked with thousands of individuals last fall, screening them to make sure they were able to find the Part D program that would fit their needs,” Boyd said, adding that many people in the commonwealth don’t take advantage of a variety of plans simply because they don’t know about them.
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