Journal Gazette: ‘Doughnut holes’ dismay seniors; Medicare recipients assail coverage gap

‘Doughnut holes' dismay seniors; Medicare recipients assail coverage gap

The Journal Gazette (Fort Wayne, IN)
By Michael Schroeder

Every morning, 84-year-old Georgian Hoevel takes nine pills, and every night, she takes 10 more.

"I go with the generics so I can keep the expenses down," said Hoevel, a Fort Wayne resident who is passionate about Medicare Part D changes. Because of what she characterizes as her declining math skills, Hoevel is unsure whether or when she'll reach the gap in her coverage.

Hoevel has Medicare Part D prescription drug coverage through United Healthcare. Her plan has no deductible, variable co-payments and covers the lion's share of drug costs until she reaches the annual limit of $2,250 in total drug costs, which include out-of-pocket costs and what the plan pays. After that she is responsible for the next $2,850 in prescription drug costs for a total of $5,100 before the catastrophic coverage kicks in to cover 95 percent of all drug expenses for the year. And all plans offer coverage when a beneficiary's out-of-pocket costs exceed $3,600.

The "doughnut hole," as it is commonly called, continued confusion about prescription drug plans and the feeling that insurance companies and pharmaceutical firms are taking them for a ride brought about 30 seniors, including Hoevel, to a town hall meeting Thursday morning at the League for the Blind and Disabled.

"This is serious," Hoevel said.

The red face of Paul Severance, founder of United Senior Action of Indiana, who convened the meeting, seemed to concur. Severance vented about problems with the plan and encouraged seniors and representatives for Sen. Evan Bayh, D-Ind., and U.S. House candidate Dr. Tom Hayhurst in attendance to advocate for change.

Severance called for a "real Medicare drug benefit" to replace the current model that incorporates private insurance companies. He also said that Medicare - not insurers - should directly negotiate fair drug prices and that individuals should be guaranteed the right to import drugs, and he called for the complete elimination of the coverage gap.

"Who ever heard of health insurance that had a doughnut hole?" he asked, rhetorically.

A handful of Indiana prescription plans have gap coverage for generic drugs with premiums starting about $39 a month, and one plan from insurer Humana Inc. provides gap coverage for both generics and brand-name drugs, with a monthly premium of $66.89. Premiums for plans without gap coverage start about $12.

Low-income beneficiaries can qualify for a zero-premium subsidy that covers the gap as well, and drugs are still discounted according to the rates negotiated by private insurers, said Bob Herskovitz, a spokesman in the Centers for Medicare and Medicaid's Chicago office, in a telephone interview.

On a separate conference call Thursday afternoon, Mike Leavitt, secretary of the U.S. Department of Health and Human Services, lauded the program's initial success.

He announced that 38.7 million Americans had Medicare prescription drug coverage, a number boosted by 2 million enrollments in the two weeks leading up to the May 15 deadline. While Bayh favored an extension of the deadline and has introduced legislation to eliminate the late-penalty, Leavitt credited the deadline with pushing the last-minute surge.

In battling for business, Leavitt added that private insurers turned in average premiums considerably lower than expected at $24, compared with the CMS actuaries'best estimates of $37.

"Competition works," Leavitt declared.

But back at the morning meeting, there was more head shaking than back patting. Change - including reducing the influence of moneyed pharmaceutical companies and insurers on Washington - couldn't come soon enough.

"You think our political system is for sale by any chance?" Severance chided.