Posts Tagged ‘doughnut hole’

The First Year for Health Care Reform – Step One

Thursday, March 25th, 2010

Though some fine tuning will be taking place, the plan for implementing the Health Care Reform Bill during the first year will (most likely) look something like this:

  • Dependent children will be eligible to stay covered under their parent’s plan until their 26th birthday. The House is still pushing to make this coverage last through their 26th birthday.
  • Insurers can no longer impose exclusions on pre-existing conditions in children. Children are considered exempt from this until their 19th birthday 
  • Lifetime maximums on benefits and annual limits on coverage will be discontinued 
  • A “high risk pool” will be created for people who cannot otherwise obtain individual coverage due to pre-existing conditions 
  • Seniors will receive a $250 rebate for help them cover the costs of their medication while in the “doughnut hole” (between $2700.00 and $6154.00) 
  • The implementation of covered preventative care services requiring no co pays

Though the final outcome is still yet to be known, these are some of the highlights of the plan of action for health care reform in 2010. Though changes will be made, and battles will be fought, we can expect some of these changes to take shape in less than 6 months from now. From then on? No one knows for sure. We do know, however, that every American will be watching and waiting to see what happens next.

Helping Seniors in the “Doughnut Hole”

Friday, July 3rd, 2009

Medicare Part D is the drug portion of Medicare coverage. It is designed to assist with the overwhelming cost of medications, but there is one major flaw in their design – the gap in coverage called the “doughnut hole”. This is when the enrollee is responsible for covering the entire cost for their medications between $2,700 and $4,350. Studies show that one in four Part D enrollees reached the doughnut hole in 2007, and numbers have only increased since then.
 
What does this mean? Considering seniors are often living on very fixed incomes, these out of pocket expenses are too high, and results in medications being halved to make them last longer, or dosages being skipped altogether. This, of course, can create a very dangerous situation to these individuals, which clearly shows that something needs to be done.
 
One of the most important changes that can help to relive some of this burden would be a break in the costs of the medications themselves. Turning to the drug manufacturers has proven helpful, as they have agreed to reduce Medicare drug costs in a number of ways. From forgoing $80 billion dollars in revenues to offering substantial discounts in the medications themselves, it seems like the drug companies and Medicare drug coverage is headed in the right direction. We can only hope things continue to improve, and coverage for seniors remains comprehensive.


© 2009 Abrams California Health Insurance Agency. All rights reserved.
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