If you want a donut hole after 2011, you will have to go to Dunkin Donuts (r)


Thank heaven I will soon be "hole" again
Thank heaven I will soon be "hole" again

Buried within the current version of HR 3200, the House health care reform bill, is the gradual elimination of the so-called donut hole for prescription coverage under Part D of Medicare.  You know, that is the program where there was no coverage for prescription drugs, coverage was added, but with limited benefits so the participants got a raw deal.  In any case, following is a cut and paste from the legislation.  While I sympathize with seniors who rely on this coverage, is a health care reform bill that is supposed to control costs the place to add substantial additional costs especially to a program that is already headed for financial disaster?  

Isn’t it curious that there has been virtually no coverage of this section of the legislation?  On the other hand, it could also be because no one is able to decipher what the heck they are saying



20  GAP.—

21 ‘‘(A) IN GENERAL.—For each year begin

22  ning with 2011, the Secretary shall consistent

23 with this paragraph progressively increase the

24 initial coverage limit (described in subsection

25 (b)(3)) and decrease the annual out-of-pocket

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1 threshold from the amounts otherwise computed

2 until there is a continuation of coverage from

3 the initial coverage limit for expenditures in

4 curred through the total amount of expendi

5 tures at which benefits are available under

6 paragraph (4).


8 LIMIT.—For a year beginning with 2011, the

9 initial coverage limit otherwise computed with

10 out regard to this paragraph shall be increased

11 by 1⁄2 of the cumulative phase-in percentage (as

12 defined in subparagraph (D)(ii) for the year)

13 times the out-of-pocket gap amount (as defined

14 in subparagraph (E)) for the year.


16  ET THRESHOLD.—For a year beginning with

17 2011, the annual out-of-pocket threshold other

18 wise computed without regard to this paragraph

19 shall be decreased by 1⁄2 of the cumulative

20 phase-in percentage of the out-of-pocket gap

21 amount for the year multiplied by 1.75.

22 ‘‘(D) PHASE–IN.—For purposes of this

23 paragraph:

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AGE.—The term ‘annual phase-in percent

3 age’ means—

4 ‘‘(I) for 2011, 13 percent;

5 ‘‘(II) for 2012, 2013, 2014, and

6 2015, 5 percent;

7 ‘‘(III) for 2016 through 2018,

8 7.5 percent; and

9 ‘‘(IV) for 2019 and each subse

10 quent year, 10 percent.


12  CENTAGE.—The term ‘cumulative phase-in

13 percentage’ means for a year the sum of

14 the annual phase-in percentage for the

15 year and the annual phase-in percentages

16 for each previous year beginning with

17 2011, but in no case more than 100 per

18 cent.


20  purposes of this paragraph, the term ‘out-of

21 pocket gap amount’ means for a year the

22 amount by which—

23 ‘‘(i) the annual out-of-pocket thresh

24 old specified in paragraph (4)(B) for the


1 year (as determined as if this paragraph

2 did not apply), exceeds

3 ‘‘(ii) the sum of—

4 ‘‘(I) the annual deductible under

5 paragraph (1) for the year; and

6 ‘‘(II) 1⁄4 of the amount by which

7 the initial coverage limit under para

8 graph (3) for the year (as determined

9 as if this paragraph did not apply) ex

10 ceeds such annual deductible.’’.

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