The Register-Herald, Beckley, West Virginia

November 8, 2012

Health care ‘donut hole’ explained

By Wendy Holdren
Register-Herald Reporter

— According to a release from the U.S. Department of Health and Human Services, nearly 30,000 West Virginians in the Medicare prescription drug coverage gap known as the “donut hole” have saved an average of $817 due to the new health care law.

West Virginians for Affordable Health Care (WVAHC) Southern Regional Coordinator Doris Selko explained exactly what the “donut hole” is and how it is closing thanks to health care reform.

Currently, there is a $320 deductible for prescription drugs in Medicare. The government then pays 75 percent and the Medicare member pays 25 percent until the total cost reaches $2,930.

At that point, the member reaches the “donut hole” and he or she is responsible for all prescription drug costs until the total out-of-pocket expense has reached $4,700.

Under the reform, any senior citizen in Medicare who reaches the donut hole in 2012 and beyond receives a 50 percent discount on all brand name drugs and a 14 percent discount on all generic drugs purchased while in the donut hole.

In the first two years since the passage of the Affordable Care Act, West Virginians covered by Medicare have saved $45 million through this provision. WVAHC anticipates that by 2020, the donut hole will be entirely eliminated.

Over 169,000 state residents with Medicare also got at least one preventative service at no cost to them during the first nine months of 2012, according to the Department of Health and Human Services.

Before 2011, people with Medicare were required to pay part of the cost for many preventative health services, making it difficult for some to get the care they needed.

Health and Human Services Secretary Kathleen Sebelius said she is pleased that the health care law is helping so many seniors save money on prescription drug expenses.

“Medicare is stronger thanks to the health care law, offering new benefits at no cost to seniors,” Sebelius said.

For more information about the Affordable Care Act and how it affects you, contact Selko at 304-673-0132.

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