Cohen and her 97-year-old mother are both in the doughnut hole because their out-of-pocket drug costs exceeded $2,700 this year. Rather than just a copay, each one now must foot the entire cost of their medications for the rest of the year, or until their annual spending reaches $4,350, which isn't likely to happen. If it does, the government will again subsidize the costs.
The Cohens, who live just north of Miami, are both on Social Security and eating through savings. Janet Cohen just learned she was in the doughnut hole when she went to pick up her supply of Aricept, which she takes for memory loss. Instead of the copay, she was charged nearly $200.
"I can't afford my medicine, is it OK if I miss like one month?" she asked the pharmacist.
He suggested taking the drug every other day, but said the effectiveness could be compromised.
Medicare Part D established a new prescription drug benefit in 2006. The doughnut hole was designed to reduce the overall cost of the program. An estimated 3.4 million seniors fall into it each year.
Most people never see the other side of the doughnut hole. They simply wait for New Year's Day. The House health care bill would close the gap gradually until it's eliminated in 2022.