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Fill the Doughnut Hole
December 17, 2009 • Volume 9, Issue 49
On the Senate floor this week, Senate Majority Leader Harry Reid, Democrat of Nevada, and Senators Max Baucus, Democrat of Montana, and Chris Dodd, Democrat of Connecticut, promised to close the gap in the Medicare drug benefit in the health reform bill they send to President Obama.
Over 3.4 million people with Medicare hit the coverage gap, or “doughnut hole,” in the drug benefit, when coverage stops and consumers must pay the full cost of their drugs. Most people who fall into the gap never get out, and spend the remainder of the year struggling to pay for medicines or, worse, skipping doses or splitting pills that are prescribed to manage chronic conditions such as diabetes or hypertension.
President Obama has already said he wants to phase out the coverage gap by 2019. The House health reform bill—H.R. 3962—already includes a phase-out by that date. This week’s commitment by Senate health care leaders means that when the Senate and House health bills are reconciled in conference, health reform legislation will close the doughnut hole, providing the most significant improvement to the Medicare benefit since drug coverage started in 2006.To make that happen, however, the Senate first has to pass its version of health reform, the Patient Protection and Affordable Care Act. Please urge your senators to close the doughnut hole in health reform.
“We all know what the consequences are when people cannot afford the medicines that they need to stay healthy, both for the affected individuals, and for society at large. Recognizing the scope of this problem, in his address to a joint session of Congress in September, President Obama promised to close the doughnut hole, once and for all, by 2019. It is our responsibility to make good on this promise and provide this needed relief to seniors. And I join my Colleagues in committing that we will send a bill to the President that closes the doughnut hole and fulfills his promise.” (Senator Max Baucus, Reid, Dodd, Baucus Commit to Closing Medicare Coverage Gap in Health Reform Bill, December 2009)
“Because the size of the gap is indexed to increases in drug costs, every year it grows more rapidly than the incomes of most seniors. The Democrats’ plan would put that into reverse, gradually shrinking and ultimately eliminating the gap.
“‘The doughnut hole would be smaller and it would start later in the year,’ said Paul Precht, policy director for the Medicare Rights Center. ‘We have gone four years with an expanding doughnut hole. For us to be headed in the other direction would be a great improvement.’
“As things stand now, seniors with low incomes are spared from having to deal with the gap. But about one-fourth of the other beneficiaries— 3.4 million people—fall into the gap.
“Anna Bollerman, a retired real estate broker, found herself pleading with doctors for free drug samples and maxing out her credit cards when she wound up in the doughnut hole this year.
“‘It put me in a position where I was totally embarrassed because I had to beg for medicine,’ said Bollerman, 80, of Bayville, N.J. She’s coping with diabetes and a serious degenerative condition that affects her eyes.
“A 90-day supply of one of her medications costs $1,496 when she’s in the doughnut hole, said Bollerman. Her monthly income is a little over $1,500.
“‘All my life I was independent, and this is what I'm left with?’ she said. ‘Whoever thought of this, it wasn't a very good idea.’”
(Associated Press, Democrats Vow to Close Medicare “Doughnut Hole," December 2009)
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This is the last regularly scheduled issue of Asclepios this year. We will resume weekly publication on January 7, 2010.
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Medicare Part D Appeals Help for Advocates Is Here!
Medicare Rights Center’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
Register for a FREE copy of this great resource.
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Medicare Part D Monitoring Project
would like to hear about your experience, or that of someone you know, enrolled in a private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed. Medicare Rights Center
Submit your story at http://www.medicarerights.org/issues-actions/tell-your-story.php.
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
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