Inside the "Doughnut Hole": Barbara's Story

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Barbara Dickman:  Senior Citizen from Westmoreland County PA

“Doughnut Hole”.  As someone that has spent most of my career in public health, I found this an odd term to use when referring to healthcare.  However, it has become a legitimate term to use when referring to the gap that many seniors on medicare experienced when they max out their basic drug benefits--at which point, they are now in the “doughnut hole”--until catastrophic drug benefits kick in (usually costing them a few thousand dollars).

In 2010 the Department of Health and Human Services estimated that almost 4 million seniors reached the doughnut hole (177,00 in Pennsylvania) and were therefore faced with the financial challenge of meeting 100% of their prescription drug costs at a time when most seniors are on a fixed income.  According to the Pennsylvania Alliance for Retired Americans, as of October 2011, 70% of Pennsylvanians reached the “doughnut hole”.  The public health challenge to this coverage gap is that the DHHS also projected that one quarter of these people stop following the prescribed regimen of drugs once they hit the donut hole.  The personal health implications and healthcare costs that follow go without saying.  

In 2010 when the PPACA was passed, all seniors that reached the doughnut hole received a $250 rebate check and beginning in 2011the doughnut hole began to close and will continue to shrink until 2020.  As a result, in 2011, 3.6 million Americans saved $2.1 billion and Pennsylvania Seniors saved $109 million ($617 for each Pennsylvanian).  

One of these seniors is Barbara Dickman, a retired stockbroker from Westmoreland County, PA.  Barbara suffers from diabetes and congestive heart failure and prior to the passage of the PPACA was paying approximately $14,000 a year out of pocket for medical costs for her and her husband.  After the passage of PPACA she shopped on the government web site where she found a more affordable medicare supplement for her and an HMO for her husband.  Their healthcare costs have decreased by almost $6,000 (most of which comes from the ‘doughnut hole‘ relief).  

¹ US Dept. of Health and Human Services Press Release, February 2, 2012

² PA Alliance for Retired People,  December 22, 2011 Press Release

³ MoscowVillager, February 3, 2012