Brown Reveals: 'Donut Hole' Fix Will Save Average Affected Senior $526 This Year; $9,000 Over Ten Years

'Donut Hole' Fix Was Five Years in Making and Passed as Part of Health Reform

WASHINGTON, D.C. – The average Ohio senior affected by the donut hole could save an estimated $526 in 2011 and $9,007 over the next decade on prescription drug costs under the completed Medicare “Donut Hole” fix that began to go into effect on Jan. 1. After many years of attempts to address the gap in Medicare prescription drug coverage, the “donut hole” is finally being fixed as part of last year’s health reform law. U.S. Sen. Sherrod Brown (D-OH) held a news conference call today to discuss how Medicare seniors will now receive a 50 percent discount on brand-name prescription drugs if they enter the “donut hole,” the beginning of a series of steps to help seniors facing prescription drug coverage gaps.

“No senior should have to choose between a meal and their medicine,” Brown said. “After years of working to fix the ‘donut hole,’ seniors will now receive a 50 percent discount on brand-name prescription drugs if they enter the gap in their Medicare coverage thanks to the health reform law. By 2020, the donut hole will be eliminated altogether.”

Brown released a county-by-county estimate today showing how the donut hole would benefit Ohio seniors. The estimate is based on the total number of Medicare beneficiaries in Ohio, more than 1.8 million seniors in 2010. Fifty-five percent of these beneficiaries are enrolled in the Medicare prescription drug benefit.  Nationally, according to a report by the Kaiser Family Foundation, as many as 14 percent of Medicare prescription drug beneficiaries exhaust benefits up to the donut hole (state specific figures were not available).

According to a report by the Centers for Medicare and Medicaid Services, the projected average savings over ten years of the donut hole fix is $9,007 per affected senior (please note: only national, rather than state-specific, averages are available for the estimated cost savings from fixing the donut hole). According to the same report, the average savings per affected senior is $553 in 2011 alone.

Since its creation in 2003, Medicare Part D has included a detrimental and costly prescription drug coverage gap, known informally as the “donut hole,” in which seniors who exceed the prescription drug coverage limit are left responsible for paying 100 percent of their drug costs, until catastrophic coverage kicks in.

After more than five years of efforts to address the donut hole, the new health reform law will fix this dangerous gap in coverage for seniors. In an effort to ease this financial burden on seniors in 2010, the new health reform law provided more than 97,000 Ohio seniors with a one-time $250 rebate check to assist with the cost of their prescription drugs. Beginning January 1, 2011, the new law provides Medicare beneficiaries with a 50 percent discount on brand-name prescription drugs and biologics if they enter the “donut hole.” Discounts will increase every year until 2020, when the “donut hole” will be completely filled and beneficiaries will only be responsible for the standard 25 percent co-insurance payment rather than the full 100 percent that they were paying prior to 2011.

COUNTY

HIGH-END ESTIMATE OF SENIORS IN DONUT HOLE*

Adams

404

 

Allen

1,393

 

Ashland

672

 

Ashtabula

1,414

 

Athens

603

 

Auglaize

559

 

Belmont

1,088

 

Brown

547

 

Butler

3,680

 

Carroll

383

 

Champaign

478

 

Clark

1,935

 

Clermont

1,901

 

Clinton

513

 

Columbiana

1,540

 

Coshocton

504

 

Crawford

667

 

Cuyahoga

17,156

 

Darke

738

 

Defiance

507

 

Delaware

1,187

 

Erie

1,098

 

Fairfield

1,473

 

Fayette

376

 

Franklin

9,969

 

Fulton

509

 

Gallia

447

 

Geauga

1,052

 

Greene

1,733

 

Guernsey

590

 

Hamilton

9,671

 

Hancock

849

 

Hardin

381

 

Harrison

242

 

Henry

370

 

Highland

555

 

Hocking

378

 

Holmes

284

 

Huron

721

 

Jackson

457

 

Jefferson

1,195

 

Knox

750

 

Lake

3,024

 

Lawrence

957

 

Licking

1,819

 

Logan

575

 

Lorain

3,562

 

Lucas

5,222

 

Madison

453

 

Mahoning

3,792

 

Marion

851

 

Medina

1,732

 

Meigs

326

 

Mercer

525

 

Miami

1,296

 

Monroe

241

 

Montgomery

7,071

 

Morgan

212

 

Morrow

368

 

Muskingum

1,189

 

Noble

163

 

Ottawa

645

 

Paulding

256

 

Perry

426

 

Pickaway

612

 

Pike

406

 

Portage

1,666

 

Preble

525

 

Putnam

410

 

Richland

1,759

 

Ross

943

 

Sandusky

793

 

Scioto

1,155

 

Seneca

768

 

Shelby

531

 

Stark

5,188

 

Summit

6,741

 

Trumbull

3,148

 

Tuscarawas

1,257

 

Union

405

 

Van Wert

400

 

Vinton

159

 

Warren

1,780

 

Washington

889

 

Wayne

1,350

 

Williams

510

 

Wood

1,286

 

Wyandot

305

 

TOTAL:

138,659

 
       

*This figure was calculated based on 55 percent of Ohio Medicare beneficiaries enrolling in the prescription drug coverage benefit. Nationally, the Kaiser Family Foundation estimates that as many as 14 percent of these beneficiaries could be affected by the donut hole (state-specific figures were not available). The 14 percent figure was applied as a multiplier to produce a high-end estimate.

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