Medicare in Florida
In 2007, Florida's Medicare enrollment was over three million people. People over 65 make up a large part of Florida's population. Florida's 22nd district, which includes the area from West Palm Beach to Fort Lauderdale, has one of the highest concentrations of Medicare beneficiaries in the United States.
Around 2004, Medicare expanded to include Part D. This program is intended to cover the cost of prescription drugs, especially those used to treat chronic condition. However, this program is not part of the original and basic Medicare, and most people must actively choose to enroll in order to be included. Beneficiaries choose their own plan among a large number available. In some states there are over 50 different plans to choose from, and coverage obviously differs between them.
The Part D Coverage Gap
In Florida and elsewhere, what most prescription drug plans (PDPs) have in common is that they suffer from what is known as the Doughnut Hole, or the Part D coverage gap. When drug costs reach a certain point, beneficiaries have to pay up to 100% of their costs until they reach the lower limit for catastrophic coverage. The exception is for people who also receive subsidies due to their low income.
This affects around 25 percent of the enrolled people who used the program. Only a few percent incurred enough expenses to leave the gap, and most had to pay their full drug costs for the rest of the year.
A 2007 study shows that 15 percent of the affected patients either stop, reduce, or change their use of prescription drugs when they reach the gap. Most of the people who end up in this situation do so because of chronic health problems such as diabetes. Therefore, the coverage gap has a large potential effect on the health of these Medicare beneficiaries.
Choosing a PDP in Florida
The Doughnut Hole is obviously a political and systematic problem, but it is also something that Florida's many Medicare-eligible citizens should take into account when signing up for Medicare Part D and choosing their plan.
In the mentioned report, Florida is singled out as having some of the best available PDPs when it comes to gap coverage. If you think you may reach the Plan D coverage gap, you should probably be looking for one of them. It may save you a lot of money in the future.
Source: RAND Corporation, news release, Sept. 11, 2007
*You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;
OR
- The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call, 1-800-325-0778; or Your State Medicaid Office.