Homer Simpson and Donut

It’s open enrollment season for seniors joining or changing their prescription drug coverage, so advice abounds on how to choose a Part D plan, how to comparison shop, etc. But what about once you’re on a plan? Merrill Goozner, of Gooznews, wrote a post last week about why the government isn’t tracking how many seniors are falling into the infamous donut hole, the gap in coverage during which your Part D pays nothing towards your drug costs:

Beyond the Donut Hole: Who’s Watching?

The famous donut hole in the Medicare prescription drug benefit — where seniors have to pick up 100 percent of costs once total expenses go beyond $2,400 a year until it hits $3,850 — was a major bone of contention when the bill passed in 2003. So you’d think the Center for Medicare and Medicaid Services would keep a close eye on how many seniors are falling into the donut hole so they can make sure they get picked up once their drug costs go above the $3,850 mark.

As they like to say in New York: fuhgeddaboudit. A new report from Health and Human Services department Inspector General Daniel Levinson shows that nearly a third of insurance companies selling drug benefit plans to seniors have not bothered to report to CMS how many seniors have fallen into the donut hole. The law required the reports.

And what is CMS doing aobut it? The agency said it had received “few complaints” from beneficiaries about companies failing to accurately calculate their out-of-pocket costs, but it would work to improve its reporting system for drug companies.

Bottom line: Seniors should closely track of their own bills to make sure their insurance companies start paying the catastrophic benefit when they reach $3,850. It’s either that or rely on your insurance company, since this government isn’t paying attention.

So, seniors with Part D plans, caveat emptor!