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June 2016
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Obamacare: So What Are We Going To Do About the “Donut Hole”?

We’re still waiting for a Supreme Court decision on the Affordable Care Act (“Obamacarem”), but if you have parents who use prescription drugs (and who doesn’t?), just a reminder that you should talk to them about how they may be budgeting for their prescription drug costs:

The spectre of senior citizens choosing between food and prescription drugs has been used by politicians so many times, it’s become a cliché. For one Cleveland couple, it could turn into a reality.

Wister Adrine, 85, takes a lot of medicines to treat his prostate cancer, congestive heart failure, hypertension and high cholesterol, said Brenda Adrine, his 61-year-old wife. Wister Adrine, a retired carpenter, has Medicare benefits that cover his health care expenses but last July, they came up short: He ran into the infamous “doughnut hole,” a gap in Medicare’s prescription drug coverage in which beneficiaries must pay the full cost for their medications.

“Once he hit that doughnut hole, I was shocked when we went to pick up his medications,” said Brenda Adrine, a retired Department of Defense employee. Drugs that had been covered with no co-payments suddenly cost $140.

Supreme Court Health Care Decision Could Boost Seniors’ Drug Costs

If you remember, one of the main objectives of the Affordable Care Act has been to close the Medicare Part D “donut hole,” the coverage gap which limits how much Medicare Part D will cover for prescription drugs. Currently, the Medicare Part D coverage gap starts when you hit $2,930 in prescription drug costs. Medicare Part D coverage picks up again once you hit $6,657 in drug costs.

In between those two points, you’re in the “donut hole.” Pre-Obamacare, seniors were usually stuck trying to cover the entire prescription drug coverage on their own, but Obamacare closes that gap over the next few years. Currently under Obamacare, Medicare Part D plan members receive a 50% discount on their brand name drugs while they are in the “donut hole.” Generic prescription drugs are discounted in the Medicare Part D “donut hole” as well. In 2012, generic drugs are discounted 14% in the “donut hole.”

If Obamacare entirely goes away, it looks like seniors will be going back to having to pick up the full costs of the “donut hole” again, so no discounts on either generic or brand name prescription drugs. That means that if you’re at or past the $2,930 in prescription drug costs for the year, be prepared to have to pay in full for the rest of your prescription drugs until you hit the $6,657. Ouch!

Are you prepared for the Medicare Part D “donut hole” to make a comeback? Tell us about it in our prescription drug forum!

Related posts:

  1. Obamacare: Should We Brace Ourselves For the Return of the “Donut Hole”?
  2. Obamacare: Will the Medicare Part D “Donut Hole” Make a Comeback?
  3. Are You in the Medicare Part D “Donut Hole” Yet?
  4. How Far Are You Into the Medicare Part D Prescription Drug “Donut Hole”?
  5. Halfway Through the Year! How Far Are You Into the Medicare Part D “Donut Hole”?

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