The Doughnut Hole and the Reform That Will Help Many Seniors

by Jenny Moore
(Warren, OH)

President Obama announced a deal between the major pharmaceutical companies and the millions of seniors on Medicare Part D's prescription plan that is poised to save 50% of the cost of brand name prescriptions for seniors in the 'doughnut hole' period of coverage.

Senate Finance Committee chairman Max Baucus, D-Mont., was a key player in brokering the deal which offers a glimmer of hope towards overall health care reform now being debated in congress. President Obama has continuously impressed that all players must come to the table, the sign that pharmaceutical companies are ready to pony up is encouraging.

How the plan is suppose to work

• All drug manufacturers agreed to donate half the cost of their brand-name and biologic products to people in the gap, at no cost to the government.
  
  
• Once enacted by Congress, Medicare Part D enrollee's will continue to get their prescriptions from their pharmacy, and the pharmacy will charge half of the price already negotiated by the Part D plan they're enrolled in. No paperwork or applications will be required.
  
  
• The full cost of prescriptions bought in the gap will count toward the out-of-pocket limit ($4,350 in 2009) that triggers low-cost catastrophic coverage, even though enrollees will actually pay only half of this amount to get there.

Very important to note, this plan is to be part of the Health Care Reform legislation now being debated in congress that President Obama would like to sign in 2009. These expected reforms would begin then in 2010. If passed, then this savings on prescriptions will be a godsend to millions of seniors, but not all seniors.

Those that will not be helped are those that pay the income-related Part B premium with incomes over $85,000 (single) and $170,000 married couples. And also low-income people who qualify for Part D's Extra Help Benefit.

To learn more, or better yet, to get involved in the effort to push health care reform, consider the following resources:

AARP has had some great success in their grass roots campaign this year with an administration open to successfully reforming health care.

President Obama is committed to working with Congress to pass comprehensive health reform this year in order to control rising health care costs, guarantee choice of doctor, and assure high-quality, affordable health care for all Americans. Visit Health Care Reform and get involved!

Need help now? See How Are You Managing the Doughnut Hole?