Medicare's "donut hole"

Discussion in 'Health Care' started by pjohns, Feb 9, 2018.

  1. pjohns

    pjohns Well-Known Member

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    It strikes me as quite reasonable to debate whether it was a good thing to establish Medicare, in the first place. (This, of course, was done as a part of LBJ's "Great Society.")

    Since it exists, however--and it surely is not going to be repealed (unless the US goes to UHC)--it does seem reasonable to inquire: Just why does the so-called "donut hole" even exist, as regarding Part D (i.e. prescription drugs)?

    (For those who are unaware, this gap, for 2018, runs from $2,700.00 to $7,508.75.)

    My wife (who has Part D coverage) just ran into this "donut hole."

    I simply cannot figure out the purpose of it--unless it is just to save the government some money.
     
  2. Lil Mike

    Lil Mike Well-Known Member

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    The Prescription Plan (Medicare Part D) was created during the Bush administration and it was designed to control costs. That's why plans compete and yes, as far as I can tell, the donut hole is just to save money.
     
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  3. pjohns

    pjohns Well-Known Member

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    Fair enough.

    But my own healthcare insurance (Blue Cross/Blue Shield) pays only for generic drugs (unless only the brand-name drug exists).

    Why not go this route--and therefore, save an enormous amount of money?
     
  4. Lil Mike

    Lil Mike Well-Known Member

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    Because the way Plan D is set up is that it provides many options for drug prescription plans that have differing costs and benefits.
     
  5. pjohns

    pjohns Well-Known Member

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    Why should that nullify my suggestion: i.e. that Medicare Part D (in all its forms) should pay for only the generic equivalent, as long as it actually exists?

    It is my understanding that paying more does not get oneself a better drug, in this regard: Even the binder must be identical, according to FDA regulations, so that the generic drug dissolves, in the system, just the same as the brand-name drug does.
     
  6. Merwen

    Merwen Well-Known Member

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    My Lipitor has a coating on it that slows absorption, but the generics I have been proffered do not, and affect me differently.
     
  7. pjohns

    pjohns Well-Known Member

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    It is difficult for me to argue with you, as you appear to be speaking from experience.

    I am speaking only from what I have read...
     
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