Washington, D.C. — U.S. Rep. Bob Etheridge (D-Lillington) today called on Congress to make changes to Medicare Part D to eliminate the “donut hole”, the part of the program that contains a gap in coverage where beneficiaries continue to pay premiums without receiving financial coverage for medicines.
On September 22, the average American senior enrolled in Medicare Part D will fall into the donut hole.
“The Medicare Part D prescription medicine program has been fundamentally flawed from day one. After months of sorting through dozens of confusing plans, seniors are now being forced to pay full price for their medicines, while continuing to pay their deductible. They are paying for a benefit they aren’t receiving,” said Etheridge.
“I voted against this faulty program, and when Congress returns from the October recess, fixing Medicare Part D should be one of our top priorities. We should go back to the drawing board and develop a plan that eliminates the donut hole and provides a real prescription medicine benefit for our seniors.”
Once beneficiaries’ annual drug costs exceed $2,250 in prescription medicine coverage, they fall into the donut hole, during which their medicine coverage is interrupted. While in this donut hole, beneficiaries pay the full cost of their medicines out of their own pockets, while still having to pay their monthly premium. Medicare then resumes coverage after the beneficiary has paid $2,850 out of their own pocket. Most seniors were unaware of the donut hole when they enrolled in the plan.
As of August 2006, there were 23,000 people in the Second Congressional District who opted to enroll in Medicare Part D. An estimated 7,600 beneficiaries in the district will hit the donut hole in 2006. For these beneficiaries, their average out-of-pocket cost in the donut hole will be $1,700. Statewide, 92 percent of seniors enrolled in Medicare Part D plans are at risk of entering the donut hole.
Etheridge is also cosponsoring the Medicare Informed Choice Act, which would waive the penalty for seniors who missed the May 15 enrollment deadline and are now subject to penalties if they choose to enroll. In the Second District, 1,450 eligible seniors who missed the deadline are subject to penalties.
The bill also allows seniors to change plans one time if they are unhappy with their choice. Currently there are 16 private providers offering 39 different plans in the Second Congressional District. The bill also protects retirees from being dropped by their former employer’s plan during the first year of the implementation of the plan.