Beneficiaries Can Delay Fall Into Medicare's `Donut Hole'

2006 ◽  
Vol 41 (19) ◽  
pp. 17-38
Author(s):  
Mark Moran
Keyword(s):  
Donut Hole

The Medicare Part D Coverage Gap, Prescription Use, and Expenditures

2018 ◽  
Vol 77 (5) ◽  
pp. 442-450 ◽  
Author(s):  
Aig Unuigbe
Keyword(s):  
Affordable Care Act ◽  
Financial Risk ◽  
Medicare Part D ◽  
Medicare Part ◽  
General Increase ◽  
Part D ◽  
Coverage Gap ◽  
Heterogeneous Effects ◽  
Drug Expenditures ◽  
Donut Hole

The Affordable Care Act has put in place policies to gradually close the Medicare Part D coverage gap (donut hole). I examine the effect of this gradual closure on total and out-of-pocket prescription drug expenditures, as well as the number of prescriptions filled. The analysis shows a general increase in prescription use. There are also heterogeneous effects, with higher total expenditure groups seeing a decrease in their out-of-pocket prescription expenditures. This suggests that closure of the “donut hole” has led to an increase in prescription use that was previously curtailed and had an impact on the financial risk faced by Medicare recipients. This has implications for trends in prescription use and Medicare expenditures in the future, as the coverage gap is closed further.

Achieving a Deeper Understanding of the Implemented Provisions of the Affordable Care Act

2014 ◽  
pp. e472-e477 ◽  
Author(s):  
Shuang Qin Zhang ◽  
Blase N. Polite
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Medicare Part D ◽  
Payment Reform ◽  
Part D ◽  
Patient Protection ◽  
Current Implementation ◽  
Donut Hole ◽  
Insurance Exchanges ◽  
Review Current

The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama on March 23, 2010. Since that time, numerous regulations have been promulgated, legal battles continue to be fought and the major provisions of the law are being implemented. In the following article, we outline components of the ACA that are relevant to cancer health care, review current implementation of the new health care reform law, and identify challenges that may lie ahead in the post-ACA era. Specifically, among the things we explore are Medicaid expansion, health insurance exchanges, essential health benefits and preventive services, subsidies, access to clinical trials, the Medicare Part D donut hole, and physician quality payment reform.

scholarly journals Addressing Insulin Access and Affordability: An Endocrine Society Position Statement

2021 ◽  
Vol 106 (4) ◽  
pp. 935-941
Author(s):  
Keyword(s):  
Low Income ◽  
Position Statement ◽  
Medicare Beneficiaries ◽  
Endocrine Society ◽  
Part D ◽  
Life Saving ◽  
Medicare Part B ◽  
Patients With Diabetes ◽  
Donut Hole ◽  
Access And Affordability

Abstract Rising costs have made access to affordable insulin far more difficult for people with diabetes, especially low-income individuals, those on high deductible health plans, beneficiaries using Medicare Part B to cover insulin delivered via pump, Medicare beneficiaries in the Part D donut hole, and those who turn 26 and must transition from their parents’ insurance, to manage their diabetes and avoid unnecessary complications and hospitalizations. For many patients with diabetes, insulin is a life-saving medication. Policymakers should immediately address drivers of rising insulin prices and implement solutions that would reduce high out-of-pocket expenditures for patients. The Endocrine Society recommends policy options to expand access to lower cost insulin in this paper.

scholarly journals The Response of Drug Expenditure to Nonlinear Contract Design: Evidence from Medicare Part D *

2015 ◽  
Vol 130 (2) ◽  
pp. 841-899 ◽  
Author(s):  
Liran Einav ◽  
Amy Finkelstein ◽  
Paul Schrimpf
Keyword(s):  
Medicare Part D ◽  
Drug Expenditure ◽  
Medicare Part ◽  
Simple Extension ◽  
Drug Spending ◽  
Baseline Model ◽  
Part D ◽  
Insurance Contracts ◽  
Donut Hole ◽  
Using Data

Abstract We study the demand response to nonlinear price schedules using data on insurance contracts and prescription drug purchases in Medicare Part D. We exploit the kink in individuals’ budgets set created by the famous “donut hole,” where insurance becomes discontinuously much less generous on the margin, to provide descriptive evidence of the drug purchase response to a price increase. We then specify and estimate a simple dynamic model of drug use that allows us to quantify the spending response along the entire nonlinear budget set. We use the model for counterfactual analysis of the increase in spending from “filling” the donut hole, as will be required by 2020 under the Affordable Care Act. In our baseline model, which considers spending decisions within a single year, we estimate that filling the donut hole will increase annual drug spending by about $150, or about 8 percent. About one-quarter of this spending increase reflects anticipatory behavior, coming from beneficiaries whose spending prior to the policy change would leave them short of reaching the donut hole. We also present descriptive evidence of cross-year substitution of spending by individuals who reach the kink, which motivates a simple extension to our baseline model that allows—in a highly stylized way—for individuals to engage in such cross-year substitution. Our estimates from this extension suggest that a large share of the $150 drug spending increase could be attributed to cross-year substitution, and the net increase could be as little as $45 a year.

scholarly journals Does Closing the Donut Hole Reduce Financial Burdens Among Medicare Part D Beneficiaries?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 906-906
Author(s):  
Yalu Zhang ◽  
Lan Liu ◽  
Jingjing Sun ◽  
Xinhui Zhang ◽  
Jiling Sun ◽  
...  
Keyword(s):  
Prescription Drugs ◽  
Medical Expenditure Panel Survey ◽  
Financial Burden ◽  
Medicare Part D ◽  
Medical Expenditure ◽  
Medicare Part ◽  
Absolute Poverty ◽  
Part D ◽  
Donut Hole ◽  
Financial Burdens

Abstract The Medicare Part D donut hole has been gradually closed since 2010. But it is still unclear how it has impacted the beneficiaries’ relative financial burdens, especially in the later stage of the closing plan. The measurement of catastrophic health expenditure induced by prescription drugs (CHE-Rx) reflects the relative financial burdens to beneficiaries’ household income, which bears more information than the measure of dollar-value expenses or the absolute poverty line used in prior studies. Using the Medical Expenditure Panel Survey 2008-2017 longitudinal national representative data and the method of difference-in-differences, this study found that the donut hole closing policy was associated with more usage of prescription drugs (b=2.84, p=0.023) and a higher likelihood of experiencing CHE-Rx (b=2.4%, p=0.011) among those who fell in the donut holes. Besides, the results show that the donut hole closing policy did not generate any immediate effects on prescription drug usage, CHE, and CHE-Rx. For the first time, this paper examined both the aggregated and marginal impact of the policy implementation, which had closed by an additional 35% between 2013 and 2017, on the relative financial burden among the beneficiaries.

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