Seniors Cope With Drug Plan ‘Donut Hole’

Michigan seniors have been hit with the full cost of brand name drugs, thanks to new legislation. Effective this year, the law eliminated Medicare’s Part D prescription drug plans offering coverage during the gap period, dubbed the “donut hole.”

People such as Janet Clapper, 72, of Battle Creek are finding out some of their brand-name drugs covered in 2006 are not covered this year. She said she reached the gap period around March or April and has had to dip into her savings for the about $700 a month cost of her multiple prescriptions. “I saved my money because I knew I’d need it when I got old, but now the government’s taken it all,” she said.

Seniors eligible for Medicare in 2006 selected from a list of competitive Part D plans offered by private insurance companies to cover the cost of prescriptions. The sign-up period generally is Nov. 15 to Dec. 31 for coverage without penalty beginning the following year. But many seniors were shocked last year to discover coverage stopped when the total cost reached $2,251. Most seniors taking expensive, brand-name drugs ended up paying thousands of dollars out-of-pocket for prescriptions mid-year. The donut-hole coverage gap lasted until the total cost hit $5,100; then emergency coverage kicked in, bringing the cost down to just a few dollars for each drug. Some plans in 2006 offered coverage during the donut hole for a higher premium cost.

This year, that’s not even an option. “Regardless of anything, I would have had to pay full price for all them drugs,” Clapper said. “That was the new law.” In Michigan, there are 1.5 million Medicare beneficiaries out of 43 million in the nation, according to a 2007 report by the Menlo Park, Calif.-based Henry J. Kaiser Family Foundation. Of the 76 plans offered to Michigan residents, 15 offer generic-only coverage during the gap period. “Which is not helpful at all,” said Jolene English, a Medicare/Medicaid assistance program counselor at Burnham Brook, 200 W. Michigan Ave. “Thirteen states changed and unfortunately, Michigan was one of them.” But overall, more seniors are pleased with their Medicare Part D prescription drug plans now that the program is in its second year, she said.

Cliff Summerhill, 65, of Battle Creek last year thought he might have to stop taking his most expensive medications so his wife, Lillian, could afford hers. But he was surprisingly pleased with his coverage this year. His physician switched him to all generic brands, which will keep him out of the donut hole as long as possible. In addition, Summerhill got a letter last week saying he would be reimbursed for a glitch that took too much out of his Social Security check for medications. As far as he understands it, his prescription drug coverage should be free until the end of the year, he said. “That damn program is confusing. There’s nothing I understand about it, but ‘free’ I understand,” he said, chuckling. Some people qualify for low-income subsidy, also called “extra help,” which covers almost all cost of brand name and generic drugs for singles with annual incomes of $14,700 or less, or couples living together with incomes of $19,800 or less this year.

“Those that are in the subsidy are totally happy, of course, because they have the full benefit there,” English said. But those who make just enough not to qualify for the low-income subsidy, such as Judy Speer, 65, of Battle Creek, have to pay much more. She would have qualified if the money she receives from her and her deceased husband’s retirement funds didn’t count. “I didn’t know where else to go (for coverage),” she said. “You either pay for it, or you pay big hospital bills.” English, however, has seen a great reduction in the number of complaint calls this year. She said her office receives about one call per day, as opposed to what felt like hundreds per day last year. “I think it’s indicative that the plans are beginning to work,” she said. Still, English is encouraging seniors to write legislators about their concerns over Part D’s lingering problems, such as the lack of gap coverage plans, expensive premiums and high cost of brand name drugs.

Genesee County’s low-income seniors who land in the donut hole also may apply for the Senior Millage Prescription Voucher Program. With a 24-hour turnaround time, seniors can get a one-time supplement of $1,000 to pay for prescriptions. That’s up from $600 last year. “It won’t get me out of the donut hole, but it will help me get my prescriptions,” said Clapper, who said she’s thankful a friend told her about the voucher.