Although the number of Medicare Part D plans will expand further in 2007, most of the stand-alone prescription drug plans and Medicare Advantage prescription drug plans offered will not provide full prescription drug coverage in the infamous “doughnut hole,” the coverage gap in the standard Part D benefit that occurs between $2,250 and $5,100 of total drug spending in 2006. So report researchers from the Henry J. Kaiser Family Foundation in a comprehensive Medicare Part D status update, published in Health Affairs online.
This year, only 4% of the 22.5 million Part D enrollees are in plans offering doughnut-hole coverage for both brand-name and generic drugs, and another 8% have coverage in the doughnut hole for generic drugs only, say the report’s authors. Subtracting out the 9.3 million low-income beneficiaries who qualify for subsidized coverage in the doughnut hole “leaves 48 percent of all Part D enrollees . . . liable for 100 percent of their drug costs if their total spending exceeds $2,250 in 2006,” according to the authors. This figure rises to 55 percent of all Part D enrollees (12.4 million beneficiaries) if those with generic-only gap coverage are included.
The number of national plan sponsors will increase to 17, up from nine this year, and there will be 31% more stand-alone prescription drug plans across the country in 2007. But the authors report that the number of plans offering full coverage in the doughnut hole remains limited.
“It is not yet clear how the Medicare Part D marketplace will evolve over the next several years, in terms of plan participation and benefits offered,” Cubanski said. “But with many new plans available next year and some notable changes to plans between 2006 and 2007, beneficiaries would be well advised to evaluate their drug plan options during the open enrollment period.” Read the report.
