My wife has Medicare. And she is currently in the "doughnut hole." The best guess, probably, is that she will remain in it throughout the rest of the year. I am wondering just why this "doughnut hole" exists, anyway (unless it is just to save the government some money). I am unaware of anyone saying, "Gee, I certainly am thrilled about the fact that Medicare has a 'doughnut hole.' In fact, I really wish that it might be expanded." The government usually responds to the wishes of its constituents. One has to wonder why this is such a glaring exception...
Well, it's for a couple reasons. 1. The large number of able bodied people on medicare combined with large numbers of baby boomers retiring 2. The large amount of medicare fraud This is why "medicare for all" simply means bad health care for everyone.
My impression was that Medicare paid 80% of all doctor and hospital costs at what they considered the prevailing rates for the area you live in??
Medicare pays 80 percent of the adjusted amount. But after one falls into the "doughnut hole," Medicare pays nothing at all, until "catastrophic care" kicks in later. (It does, however, continue doing its "write-offs," or "adjustments"--which is helpful.) The Medigap policy that my wife has, however, pays nothing at all in the event that Medicare pays nothing. (As long as Medicare does pay on a particular claim, it pays 100 percent of the remainder. But if Medicare does not pay--well then, the Medigap policy does not pay, either.)
There are three parts to Medicare. Part A is the catastrophic coverage for hospitalization. Medicare pays all of it. It is free to those 65 years old or older. Part B is an optional coverage for medical issues not requiring hospitalization and is paid by the insured. It pays 80% of covered costs. People can buy coverage for the other 20% from insurance companies. The third one and the one that has the donut hole is part D which is coverage for prescription drugs. It is purchased by the insured from an insurance company and is subsidized by the Medicare system. The donut hole is simply a coverage gap at the start of coverage. There will be no donut hole beginning in 2019.
