Falling into the benefits gap known as the doughnut hole—and how to climb out
Medicare Part D doesn’t cover yearly prescription drug costs above $2,250. But at $5,100, annual drug costs become “catastrophic expenses” and benefits kick in again. Positive people who’ve fallen into the gap between those figures call it “the doughnut hole.”
Are you in the hole? If you’re a Part D beneficiary with an income above 150 percent of the federal poverty level, you can’t get special low-income Medicare assistance. You may find yourself choosing between paying thousands of dollars for meds—or going without. In 2006, the government says, about 20 to 30 percent of HIV-positive Medicare beneficiaries fell in the gap.
Can you escape? Medicare offers plans with better coverage to bridge the gap—but often at high premiums. Another option: Contact your state AIDS Drug Assistance Program (ADAP). (Find your ADAP at atdn.org/access/states; 800.734.7104.)
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Previous Comments:
comments 1 - 3 (of 3 total)
Jack, San Francisco, 2008-05-22 14:54:30
It is clearly impossible for you all to understand what it's like to be too poor to pay for your own healthcare. These medications are not optional, they are literally life saving. I can't live the rest of my life like this. Your solutions, pay more money and ADAP are a JOKE. Stop being apologist for the system and speak up!! There is a word for what is happening here, murder. Of course you don't believe me.
Donald Worth, Youngstown, 2008-05-22 11:47:20
I'm preparing to die. I live in the state of Ohio, and there is a budget crisis going on in Columbus. Who knows how long the ADAP program will be able to continue this coverage for the doughnut period for HIvers. I believe the state will eventually choose to save funds over lives.
Linda, jonesboro, 2008-05-22 09:49:39
My love one fell in the hole. He was getting a disability check for about 600. They put him on SSI which increased his money to 1200. He can't get medicaid. And he was not inform of this. When it was time to get a refill he could not get his meds. He got sick and has been going down hill since. He has gotten a Grady card, and is receiving help. But he is fighting to get back. With no insurance to cover burial. I have been praying that GOD don't send the death angel until i raise the money.
