The doughnut hole in Medicare D—the point at which beneficiaries have used up their coverage and must pay out of pocket until they qualify for “catastrophic” care—appears to be one mighty big hole.

More hole than doughnut? Not quite but the hole is bigger than it ought to be. The list of conditions which are most likely to throw people into the hole are common among elderly people—dementia, diabetes, heart disease, emphysema, congestive health failure and other mental health conditions.

Heart. Lung. Kidney. Brain. Endocrine system (diabetes).

Sixteen percent of  the 287,000 beneficiaries whose records were examined in this study entered the doughnut hole. Only seven percent of those qualified for catastrophic coverage.

HealthDay News/Business Week

“Among elderly Americans, women and those with diabetes and dementia are most likely to find themselves in the Medicare Part D drug plan “doughnut hole,” the coverage gap that occurs after a beneficiary has reached the annual coverage limit but hasn’t spent enough on drugs to qualify for catastrophic coverage.

“Researchers analyzed the records of more than 287,000 Medicare enrollees in eight states and found that 16 percent of them entered the doughnut hole. Nearly 3 percent entered the gap very early — within the first 180 days of the year. Of the enrollees who entered the gap, only 7 percent eventually qualified for catastrophic coverage. (Emphasis added)

“Along with women and patients with dementia and diabetes, patients most likely to fall into the doughnut hole included those with end-stage renal disease, coronary artery disease, chronic obstructive pulmonary disease, mental health conditions and congestive heart failure.” (Emphasis added)

Source: HealthDay News/Business Week, March 29, 2010