You may have read last week about an agreement struck by Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, to reduce the cost of some drug purchases by 50% for many seniors who participate in the Medicare drug program, Medicare Part D.
If enacted, the deal would be good for the 3 million or so Medicare Part D participants who don't get assistance from the federal or state governments when they reach the so-called doughnut hole. The doughnut hole starts when the consumer plus the drug plan the consumer selects (which pays much of the cost of qualified drugs) have together spent $2,700 on prescription drugs. The hole only ends after the consumer alone has spent $4,350 out of pocket. (Those caps will likely rise in 2010.)
During the doughnut hole, Part D participants pay the full price of their medicines.
The Baucus half-off plan would take effect within the doughnut hole. Not only would the cost of the drugs be halved, but Medicare Part D plans would give credit for the full cost -- helping people with high drug costs get through the doughnut hole period faster.
But don't count on those savings yet. Though the drug trade association PhRMA, members of Congress and President Obama have signed off on the deal, the earliest it could go into effect would be July 2010.
And it may not even happen. The drug savings would be just one piece of the health reform legislation beginning to wend its way through Congress, and the fate of that legislation is uncertain.
What about dealing with the hole right now?
Many people are wrestling with this issue: The advocacy group California Health Advocates of Sacramento says that 15% to 26% of phone calls to its hotline last summer were about the doughnut hole.
If you're just turning 65 and now eligible for Medicare Part D, read our story from November to learn how to sign up: articles.latimes.com/2008/nov/24/health/he-medicare24.
And if you are facing the doughnut hole right now, there are ways to cut costs. Our suggestions:
Start with one-on-one counseling with your county's Health Insurance Counseling and Advocacy Program (HICAP) office. Call (800) 434-0222 to speak with a consultant. In Los Angeles, the office is called the Center for Health Care Rights. Reach them at (800)824-0780 or (213) 383-4519.
Check the California Health Advocates website ( www.cahealthadvocates.org) for an exhaustive list of resources. Go to the home page, click on prescription drug coverage, then click "resources." We've listed the ones we think are easiest to access and use below.
