Vast Majority of Senior Citizens Do Not Understand Donut Hole in Medicare Drug Program

What’s Your Gap? Three simple steps to make the most of your Medicare Part D coverage and delay the Coverage Gap

If you are still confused about the coverage gap – or donut hole – in the Medicare Part D drug program, don’t feel dumb or alone. Nearly two-thirds of senior citizens covered by the program don’t understand it, although, it is a key part of the program and can lead to devastating unexpected drug costs.

A new national poll titled “What’s Your Gap? Seniors Struggling with the Medicare Coverage Gap,” has found that 56 percent of the eligible population enrolled in the Medicare Part D program, more than one in four beneficiaries, either don’t understand the Coverage Gap at all, or simply don’t know what the Coverage Gap is.

“Seniors are in the dark about the Coverage Gap,” says Dr. Richard Dupee, president of the Massachusetts Geriatric Society and chief of geriatrics at Tufts Medical Center. “Without knowing how the Coverage Gap works, it’s simply impossible to take steps to push off or prevent it.”

To address this issue, Medco Health Solutions, Inc., the company that financed the survey, unveiled today a multi-level initiative aimed at educating retirees about the Coverage Gap, and what steps they can take to stave off or even prevent them from falling into the “doughnut hole.”

The program, “What’s Your Gap?” provides retirees with information about prescription drug savings opportunities, where to look for hidden savings, and clarifies many misconceptions about the Coverage Gap. For example, Part D beneficiaries can save up to 38 percent and delay entering the Coverage Gap by an average of two and a half months by choosing both generics and mail order.

As part of the initiative, Medco has developed a free consumer’s guide called “What’s Your Gap? Three simple steps to make the most of your Medicare Part D coverage and delay the Coverage Gap.”

The free guide presents easy-to-understand information on savings tools that are largely unknown or underutilized by beneficiaries and how to track your drug costs against the Coverage Gap.

The guide is available free to consumers in a downloadable version at, or by sending a postcard requesting the guide to “What’s Your Gap?”, PO Box 8007 Parsippany, NJ 07054-8007.

Key findings of the Medco Survey include:
Gap Hits Those with Chronic Diseases: Among respondents who are already in the Coverage Gap in 2008, more than three out of four regularly take medications to treat more than one chronic condition; among respondents, 43 percent indicated they had reached the Coverage Gap before June of 2008.

Missing Out on Savings: Nearly 28 percent of survey respondents have not used any lower-cost options to reduce their prescription price tag to delay entering the gap. Furthermore, fewer than one in four (23 percent) enrollees have discussed ways to reduce their prescription drugs costs with their physicians. Only 19 percent of respondents indicated they have used a mail-order pharmacy to reduce their drug costs.

In 2008, once Medicare enrollees spend a total of more than $2,510 on prescription drugs in the initial phase of coverage, they enter the Coverage Gap and become responsible for the full cost of their medications. In 2009, the Coverage Gap shifts to total drug costs exceeding $2,700.

Beneficiaries Don’t Know What Costs Count Toward the Gap: According to the survey, one of the root causes of confusion is that Medicare beneficiaries simply don’t know what parts of a prescription’s price count towards the Coverage Gap. Only one-quarter of enrollees polled correctly stated that the total cost of a drug – both their out-of-pocket cost and the health plan’s portion of the drug price – count towards the Coverage Gap.

“It’s one of the great Medicare myths – that only copays or out-of-pocket costs count towards the doughnut hole,” says Dr. Dupee. “This misunderstanding gives many seniors a false sense of security that the Coverage Gap is months away, when in reality, it could hit them with their next refill.”

Bridging the Communication Gap: Recognizing the significance of educating enrollees about the specifics of the Coverage Gap, Medco has implemented an integrated Coverage Gap communications program that alerts its Prescription Drug Plan (PDP) members and specific health plan beneficiaries through mailings and outbound phone calls of their proximity to the Gap long before they reach it.
Additionally, any time one of these members contacts a customer service representative for any reason, that member can be provided with a real-time Coverage Gap status update. To promote increased use of generics in order to help members delay entry into the Coverage Gap, Medco also offers members prescription forms that they can bring to their physician or will contact the doctor on their behalf to discuss generic alternatives that can lower the patient’s medication costs.

Source: and

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