New Medicare plan 'doughnut hole' to affect seriously ill seniors

PHILADELPHIA, Pa. - The new Medicare plan aims to lower the personal cost of prescription medications to many older adults. Research published in the Journal of the American Geriatrics Society found that for those patients with more serious illnesses, the out of pocket costs for those medications will still be high. The more advanced drugs used to treat these diseases are far more expensive and often elevate the patient into the "doughnut hole" range of no coverage.

The standard benefit design calls for each beneficiary to pay for 100% of drug expenses between $2,250 and $5,100. A serious illness such as diabetes mellitus effects 20% of older adults 64% of them will have medication expenses exceeding $2,250. This leaves the patient to pay out of pocket for that gap in coverage.

"In this situation, patients may use fewer medications or have to choose which medications to buy to meet their budget in a given month" says lead researcher Dr. Jennifer Tjia. For seriously ill patients, this can be a risky choice. Physicians will need to consider the cost of the medications they are prescribing and consider about the economic implications of their recommendations.


Jennifer Tjia, MD, MSCE is currently an instructor in Medicine at the University Of Pennsylvania School Of Medicine. Dr. Tjia is also a staff physician at the Hospital of the University of Pennsylvania and the Presbyterian Medical Center. Dr. Tjia is available for further information or interview at (267) 992-8216.

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Last reviewed: By John M. Grohol, Psy.D. on 30 Apr 2016
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