New research suggests only about 8% of Medicare beneficiaries will fall into the coverage gap for prescription drug benefits.
Under the Medicare drug benefit that went into effect this year, beneficiaries who exceed coverage limits would become fully responsible for prescription drug costs they incur, up to a specified dollar amount.
Under the law that created the Medicare Part D prescription drug coverage, annual out-of-pocket drug spending between $2,250 and $3,600 is not covered by the standard benefit. The coverage gap between these upper and lower limits is known as the “donut hole.”
The new study, prepared by PricewaterhouseCoopers L.L.P. and commissioned by the Healthcare Leadership Council, Washington, shows more than 90% of Medicare beneficiaries will either not reach the coverage gap or will have at least some coverage available to them in the gap.
PricewaterhouseCoopers researchers found Medicare beneficiary drug coverage breaks down as follows:
38% of beneficiaries have prescription drug coverage from plans outside of Medicare Part D.
23% will be eligible for low-income subsidies and, therefore, won’t enter the donut hole.