Part D: Low-Income Elders, the Donut Hole and the Election

By Rosenblatt, Robert A. | Aging Today, May/June 2006 | Go to article overview

Part D: Low-Income Elders, the Donut Hole and the Election


Rosenblatt, Robert A., Aging Today


Millions of Americans can still enroll in the new Medicare Part D prescription-drug benefit even though the first deadline has come and gone. For most of the 42 million people on Medicare, May 15 was the well-publicized date for them to sign up. Now, the books won't open again until November 15, the start of the open enrollment season for 2007.

THE INCOME TEST

There is a notable exception to this rule: those who are eligible for extra financial help in paying for this new benefit. The low-income subsidy (LIS) was designed for a hard-to-reach group, people who have too much money to qualify for Medicaid-the federal program for the lowest-income group of Americans-but too little to be able to afford to pay for prescription drugs on their own. They are hard to find and hard to convince that a government program would do for them what it promises. Finding them and signing them up is just one of several challenges facing the Part D program-issues that will preoccupy consumers and state and federal officials, as well as candidates running for Congress, in the coming months.

To be eligible for the LIS, individual Medicare beneficiaries must meet an income test for annual earnings: up to $14,700 for an individual and $19,800 for a married couple Iiving together. They also are limited in assets to $i 1,500 for an individual and $23,000 for a couple living together. Assets do not include the value of the primary home and a car. They do include stocks, bonds, savings accounts and cash. Assets calculations can exclude $1,500 as a set-aside for funeral costs.

Depending on their income and assets, eligible beneficiaries could receive the benefit virtually without charge, having to make only modest co-payments for prescriptions. It is a two-step process: First, they have to be ruled eligible by the Social Security Administration (SSA), which handles the applications; second, they have to select and enroll in a Part D prescription plan. They can do this at any time.

The government originally estimated that about 8 million Medicare beneficiaries were eligible for the LIS. About 4 million applied, but more than half had too much in assets to qualify. About 1.7 million have been approved by SSA for the coverage.

For those already enrolled in Medicare Part D, who have significant drug bills, the "donut hole" is looming and could be a financial chasm. The donut hole is the gap between which coverage is suspended and doesn't return until huge bills have been amassed. Hundreds of different insurance policies are being marketed under Part D, but they all must have a $250 deductible, with the government paying 75% of the first $2,000 in drug costs. The donut hole becomes a reality when total spending has reached $2,250. Coverage stops. The patient pays the full bill until total outlays reach $5,100. The patient already has paid monthly premiums, a deductible and co-payment for medications, so the total spending figure of $5,100 translates into $3,600 in out-of-pocket spending by the consumer. After that point, the government picks up 95% of the cost of future prescriptions.

ASSISTANCE PROGRAMS

Now there is a possibility of filling that donut hole. Before the Medicare drug law was passed, many large drug companies had prescription assistance programs for lowincome people that provided discounted or free medications. The programs continued for those under age 65 when the Medicare drug benefit began last January, but some companies dropped these programs for those enrolled in Medicare. Some firms said they feared that giving away medications could violate federal antikickback laws that say a company can't steer beneficiaries toward their own products by giving free merchandise. The Inspector General of the Health and Human Services Department issued an advisory opinion in October that the programs might be violations of the law. But he issued a new statement in April saying the programs are acceptable. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Part D: Low-Income Elders, the Donut Hole and the Election
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.