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The Impact of Health Care Reform on the Medicare Part D Donut Hole

The Impact of Health Care Reform on the Medicare Part D Donut Hole Prepared by the Health Law and Policy Clinic of Harvard Law School and the Treatment Access Expansion Project www.taepusa.org. Catastrophic Coverage. Total Spending. $0- $310. $310-$2,830. $2,830 -$6,440. 75% Plan Pays.

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The Impact of Health Care Reform on the Medicare Part D Donut Hole

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  1. The Impact of Health Care Reform on the Medicare Part D Donut Hole Prepared by the Health Law and Policy Clinic of Harvard Law School and the Treatment Access Expansion Project www.taepusa.org

  2. Catastrophic Coverage Total Spending $0- $310 $310-$2,830 $2,830 -$6,440 75% Plan Pays 80% Feds Pay Reinsurance “Donut Hole” Coverage Gap $ + Deductible ≈ 95% 25% out-of-pocket Consumer Out-Of-Pocket 15% Plan Pays 5% out-of-pocket $310 $630 $3,610 Total consumer out of pocket = $4,550 Consumer Pays Private plan Pays Federal Government Pays Medicare Part D Coverage: The Donut Hole in 2010 (pre-reform)

  3. Catastrophic Coverage Total Spending $0- $310 $310-$2,830 $2,830 -$6,440 $250 75% Plan Pays 80% Feds Pay Reinsurance “Donut Hole” Coverage Gap $ + Deductible ≈ 95% 25% out-of-pocket Consumer Out-Of-Pocket 15% Plan Pays 5% out-of-pocket $310 $630 $3,610 Total consumer out of pocket = $4,550 - $250 rebate = $4,300 Consumer Pays Private plan Pays Federal Government Pays Post-Reform Medicare Part D Coverage: The Donut Hole in 2010

  4. Catastrophic Coverage Catastrophic Coverage $2,830 - $17,270 Total Spending $0- $310 $310-$2,830 $2,830 -$6,440 75% Plan Pays 75% Plan Pays 75% Plan Pays 80% Feds Pay Reinsurance 80% Feds Pay Reinsurance “Donut Hole” Coverage Gap $ + Deductible ≈ 95% 25% out-of-pocket Consumer Out-Of-Pocket 25% out-of-pocket 25% out-of-pocket 15% Plan Pays 15% Plan Pays 5% out-of-pocket 5% out-of-pocket $310 $630 $3,485 $3,610 Total consumer out of pocket = $4,550 Total consumer out of pocket = $4,550 Consumer Pays Private plan Pays Federal Government Pays Post-Reform Medicare Part D Coverage: The Donut Hole in 2020 (generic)

  5. 25% Plan Pays 50% Manufacturer Discount as TrOOP 25% out-of-pocket $1,203 Total consumer out of pocket = $2,143 Post-Reform Medicare Part D Coverage: The Donut Hole in 2020 (brand-name) Catastrophic Coverage - $7,643 Total Spending $0- $310 $310-$2,830 $2,830 -$6,440 75% Plan Pays 80% Feds Pay Reinsurance “Donut Hole” Coverage Gap Deductible ≈ 95% 25% out-of-pocket Consumer Out-Of-Pocket 15% Plan Pays 5% out-of-pocket $310 $630 $3,610 Total consumer out of pocket = $4,550 Consumer Pays Private plan Pays Federal Government Pays

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