Making it through the donut hole

Marketplace Staff Jul 28, 2006


KAI RYSSDAL: Donut hole. A tasty treat. Delicious with a cup of coffee. But for millions of seniors it’s shorthand for something that leaves a bad taste in their mouths. Under the new Medicare drug benefit, seniors are covered until bills reach about $2,200 a year. Then they pay for everything till the total bill reaches just over $5,000. Then benefits kick in again. Hence, donut hole. So what can people do to help fill it in? From the Marketplace Health Desk at WGBH, Helen Palmer has the story.

HELEN PALMER: Sandra Goldblatt reached the Drug Benefit gap months ago.

SANDRA GOLDBLATT: Hi come on in, I’m Sandra, come in, make yourself at home.

She lives in a mobile home with a small garden in Santa Ana, Calif. She’s had multiple sclerosis for 12 years and she takes plenty of meds.

GOLDBLATT: I take approximately 18, let’s see, about 18-19 tablets.

She needs all these drugs because of her disease and its side effects, but some cost hundreds of dollars.

GOLDBLATT: One of my meds which costs $1,500 a month I can’t afford to get.

Since Goldblatt landed in the donut hole, she’s been scrambling for ways to afford her meds while paying her bills. She’s typical of many disabled people on Medicare, The cost of their drugs landed them in the donut hole within the first couple of months of the year.

The federal government has advice for people who reach to gap. Charlotte Yeh is a Medicare administrator.

CHARLOTTE YEH: First talk to your physician or pharmacist to see if there’s a generic drug that’s the same drug but cheaper. You could begin looking at your options for health plans that have coverage through the coverage gap so come November you can sign up for one of those plans.

Yeh says patients should look for pharmacy assistance programs. Some states have them and some drug companies are still providing free or cut-price drugs.

Consumer organizations like the Center for Medicare Advocacy try to help as well. But Robert Hayes, director of the Medicare Rights Center says charity programs have been cut back sharply since the drug benefit kicked in. And cut-price drugs create problems for people in the hole.

ROBERT HAYES: On the one hand, of course they want to find the most affordable way to buy the medicine while they’re in the donut hole. On the other hand, most of the ways to get discounted medication while in the donut hole will work against you.

That’s because if you buy discounted meds it’ll take longer to close the gap.

HAYES: You have to spend out of pocket out of your own money, $3,600. That doesn’t count the premiums you pay. It would not count for instance drugs you might go to Canada to buy because they may be cheaper.

Drugs from Canada aren’t legal, of course, but that doesn’t stop Joan Katz.

Katz, an active 80-year-old, lives in a retirement village in leafy Southbury, Ct. She takes about half a dozen medications and signed up for the drug benefit in May.

She tallied up her costs on yellow legal pads. She’s doing her best not to fall down the hole.

JOAN KATZ: Since I went on Part D in early May, I spent a total of $1,500, a little over $1,500, which meant to get to the donut hole I had about $747 left.

Katz expects to hit the gap in October. She’s done the math and knows she won’t spend enough to get out of it by the end of the year so she’s cutting costs now. She takes generic meds for cholesterol and ulcers, and gets mail order pills from Canada.

KATZ: If I pay for Fosamax, for example, here it’s $88 retail. In Canada it costs about $33 last I heard, but that’s it, that’s the only cost.

Back in California, Sandra Goldblatt still needs to spend $1,900 out of pocket before her coverage resumes. Shared Solutions is supplying her most expensive medication. It’s an organization for patients with MS funded by drug companies. She’s also looking for help from the National Organization for Rare Disorders.

GOLDBLATT: Unfortunately because they ran out of funding, they have no funding. But I’ve been approved once they get funding.

In the meantime, Goldblatt juggles her expenses as best she can and actually goes without some drugs.

GOLDBLATT: There’s different things that you have to do to make ends meet, because you’ve got to pay the rent, you’ve got to pay for food and you’ve got to pay for your meds somehow.

For many seniors in the donut hole, that’s a real problem, without many good solutions.

In Boston, I’m Helen Palmer for Marketplace Money.


Call or log onto your health plan provider – their customer service reps will try to help.

There’s a lot happening in the world.  Through it all, Marketplace is here for you. 

You rely on Marketplace to break down the world’s events and tell you how it affects you in a fact-based, approachable way. We rely on your financial support to keep making that possible. 

Your donation today powers the independent journalism that you rely on. For just $5/month, you can help sustain Marketplace so we can keep reporting on the things that matter to you.