Medicare donut gap to close significantly News added by Benefits Pro on October 31, 2013

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Joined: September 07, 2011

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By Kathryn Mayer

Just 9 percent of beneficiaries will hit Medicare’s coverage gap — aka the donut hole — in 2013, a huge drop from 33 percent who fell into it last year.

Projections were made by eHealth, which analyzed more than 17,000 of their own user sessions during last year’s Medicare enrollment.

That means the vast majority of seniors— 91 percent — will not hit the Medicare prescription drug donut hole at any time in 2013. Among users who will hit the donut hole in 2013, nearly two-thirds (62 percent) will hit the donut hole between September and December in their existing Medicare prescription drug plan.

Seniors fall into the donut hole when combined drug spending — from both the individual and the carrier— reaches a certain threshold.

Transitioning to generic drugs might be the main factor for the drop, eHealth spokesman Nate Purpura said.

“Popular name drugs taken by seniors have gone generic, Lipitor being a big one,” he said.

Though the results about the donut hole are “good news for seniors,” Purpora said he’s still concerned with widespread confusion and inaction during Medicare open enrollment.

“I’m concerned 78 percent of seniors still don’t do a full comparison on prescription drugs [during Medicare enrollment] — that’s concerning because the average person saves a great deal of money when they compare,” he said.

The company’s research also found that the average person on at least one prescribed medication would save an average of more than $1,200 in out-of-pocket prescription drug costs in this enrollment year by signing up for Part D coverage, either through a PDP or an MAPD.

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