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Thread: Medicare's "donut hole"

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    pjohns's Avatar Senior Member
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    Medicare's "donut hole"

    It strikes me as quite reasonable to debate whether it was a good thing to establish Medicare, in the first place. (This, of course, was done as a part of LBJ's "Great Society.") Since it exists, however--and it surely is not going to be repealed (unless the US goes to UHC)--it does seem reasonable to inquire: Just why does the so-called "donut hole" even exist, as regarding Part D (i.e. prescription drugs)? (For those who are unaware, this gap, for 2018, runs from $2,700.00 to $7,508.75.) My wife (who has Part D coverage) just ran into this "donut hole." I simply cannot figure out the purpose of it--unless it is just to save the government some money.

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    pragmatic (02-09-2018)

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    ripmeister's Avatar Senior Member
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    Actually this is a timely post as I just read something today that in the new budget agreement the donut whole is being addressed and Big Pharma is not happy. I don't know the answer to your question off hand but it looks like some relief is in site.
    One can be sure that he who says he knows knows nothing

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    Chris's Avatar Senior Member
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    I recently had the donut hole explained to me by an agent. Way I understood it was while in the hole you pay more OOP not all, but it was confusing.

    Why does the government do anything? Some genius central planner...

    While on the topic, if you did not have insurance, then for every month you didn't have Plan B but could have had it, you pay extra 10% for each month, for life. Why are you penalized for not signing up? It cost the government nothing. I asked agents and even Medicare people but no one could say why.

    Why does the government do anything? Some genius central planner...
    Tradition is not the worship of ashes, but the preservation of fire. ― Gustav Mahler

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    pjohns (02-10-2018)

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    Kacper's Avatar Senior Member
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    Doesn't affect me personally, but I used to help out some elderly folks with this and the whole Medicare D thing always struck me as a sham. All you are really getting out of it is the negotiated discount. The people end up paying most of it out of pocket all along and that counts against them toward the gap and then they have to pay the gap out of pocket too. Sad part was they were on a program to get prescriptions $20-$30/90 supply until Medicare D was enacted at which point they became ineligible. One of them's bottomless doughnut hole was about to bankrupt me every fall.

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    AZ Jim (02-09-2018),pjohns (02-10-2018)

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