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Closing the Doughnut Hole

With prescription drug costs skyrocketing, the Medicare Part D “doughnut hole” is severely hurting millions of seniors, who are overwhelmed by thousands of dollars in out-of-pocket expenses—and going without the medicine they desperately need.

In a recent letter, AARP thanked Senate leaders for their commitment to closing the Medicare Part D coverage gap by 2019 during the upcoming House-Senate conference committee on health reform legislation.

Massachusetts Senator John Kerry (D) has been working to close the doughnut hole and strengthen Medicare benefits. Said Kerry, “Now is our chance to close the gap.”

Stuck in the Gap

In the Bay State, approximately 25% of Medicare beneficiaries with drug coverage fall into the doughnut hole at some point during the year. In 2010, this means that they must pay $4,550 out of pocket for prescription drugs until coverage resumes.

Salem resident Patricia Liberti, 59, is all too familiar with this scenario. Last year, Liberti and her husband spent upwards of $15,000 on health care costs. In September, they reached the Medicare coverage gap or “doughnut hole.” “I have coronary-artery disease and had to go on disability about 10 years ago,” she explains. “As a result, I am on Medicare and have hit the doughnut hole repeatedly. Each time, I dip into my retirement savings to pay for my medicine—which costs about $1000 a quarter. Sooner or later, there won’t be any savings left.”

Making Progress

AARP believes the Senate’s Patient Protection and Affordable Care Act would protect and improve the guaranteed benefits the people in Medicare rely on, and make progress toward ending the discrimination used by insurers to deny coverage to those who need it most.

“This legislation helps ensure older Americans can afford quality health services,” says Deborah Banda, AARP Massachusetts state director. “It is needed to lower drug costs, limit age discrimination by health insurance companies and strengthen long-term care.

“We believe this legislation can be improved further in conference,” Banda continues, “and we will continue working with the Massachusetts delegation to make meaningful health care reform—hat includes closing the Medicare doughnut hole—a reality.”

Find out More

Avoid the dreaded coverage gap. The AARP Doughnut Hole Calculator is a free online resource designed to help you find out how long your coverage will last before you fall into the doughnut hole. You’ll also receive a list of less expensive, but equally effective medications that you can discuss with your doctor.

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