I saw Forbes Avik R's blog post on May 22 explaining why Medicare Part D's donut hole should not be "closed" and I emailed him what I had written here back in February: The Part D Donut Hole is Much Ado about Nothing, at least here in Massachusetts.
My point back in February and in my email to Avik was that the much discussed donut hole only affected a relatively few seniors and other Medicare beneficiaries (given the size of Medicare) and only the relatively well off (given the Social Security Extra Help program and State Pharmaceutical Assistance Programs - SPAPs - in many states).
But he did give me a hat-tip for alerting him to the SPAP angle, which he discovered applies in 22 states.
Number crunching aside, I disagree with his overall opinion. One of the dirty little Obamacare secrets is that it doesn't really "close" the donut hole.
- There are still three complicated spending phases for seniors to figure out and that doesn't change after 2020 as many politicians claim.
- There is still the need for hole-filling policy riders, like Forbes discusses in the linked post, or for SPAPs, depending on where you live.
- There is still no truly catastrophic coverage for people who really need it (like for $25,000 a year worth of Enbrel for RA or hundreds of thousands of dollars a year for cancer or hemophelia), which should be the real purpose of insurance.
I say price out the Medicare Part D program the way real insurance works with the deductible at the beginning and the coverage on the high side and truly get rid of the donut hole. Because the hole affects so few of us seniors (and none of the poor), the effect on the rest of us seniors will not be that big a deal. And we may get RA some day.
-- Dennis Byron