Coverage Gap / Donut Hole
This weekend I learned the hard way what a Donut Hole (no, not Timbits, but medical insurance) is. I went to refill a prescription and was told that I have entered a donut hole in my coverage and owed $1200 for my prescription. I about fainted!
I have heard people discuss the Medicare donut hole, but really didn't understand what it meant. For those of you who are ignorant like me, a donut hole is when your insurance has paid out a certain amount of money and suddenly they stop covering you for a period of time.
In my case, since January 1 my insurance has already paid out over $4330, so suddenly the burden of coverage switches over to me. I am now in a coverage gap stage until my out of pocket costs reach $4550, then my coverage will kick back in. In my case, that $4550 will be paid out before the end of February (many of my drugs cost $2000+ per month). So, to give you the big picture, I will have already spent 1/3 of my total yearly social security income for 2010 by the end of February, leaving me with 2/3 to cover every other expense (medical, grocery, utilities, transportation, etc.) for the rest of the year.
All I can say is, thank God so many people donated money to help us with our medical expenses. I still have an account set up to cover things like this, but what about someone who doesn't have help? Many of our elderly are covered by these kinds of plans, how can they afford to continue paying for their medications during this medi-gap period? 1/3 of your yearly income for prescriptions is a lot of money when you are on a fixed income. I know for a fact, many of these people end up going without medications they need because they cannot afford them. Why are we penalizing our elderly and disabled in this way?
Health care is so complex and as Scott reminded me last night, it has become my full time job. I have to say, I often feel like quitting! I just hope I can help educate others about things like this donut hole as I learn about them, so they won't have to face medical issues blindly.
I hope you all have a wonderful week! Nancy
I have heard people discuss the Medicare donut hole, but really didn't understand what it meant. For those of you who are ignorant like me, a donut hole is when your insurance has paid out a certain amount of money and suddenly they stop covering you for a period of time.
In my case, since January 1 my insurance has already paid out over $4330, so suddenly the burden of coverage switches over to me. I am now in a coverage gap stage until my out of pocket costs reach $4550, then my coverage will kick back in. In my case, that $4550 will be paid out before the end of February (many of my drugs cost $2000+ per month). So, to give you the big picture, I will have already spent 1/3 of my total yearly social security income for 2010 by the end of February, leaving me with 2/3 to cover every other expense (medical, grocery, utilities, transportation, etc.) for the rest of the year.
All I can say is, thank God so many people donated money to help us with our medical expenses. I still have an account set up to cover things like this, but what about someone who doesn't have help? Many of our elderly are covered by these kinds of plans, how can they afford to continue paying for their medications during this medi-gap period? 1/3 of your yearly income for prescriptions is a lot of money when you are on a fixed income. I know for a fact, many of these people end up going without medications they need because they cannot afford them. Why are we penalizing our elderly and disabled in this way?
Health care is so complex and as Scott reminded me last night, it has become my full time job. I have to say, I often feel like quitting! I just hope I can help educate others about things like this donut hole as I learn about them, so they won't have to face medical issues blindly.
I hope you all have a wonderful week! Nancy
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