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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. - PowerPoint PPT Presentation
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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
Medicare Part D Coverage: The Donut Hole in 2010 (pre-reform)
$0- $310
$ +
Consumer Pays
Deductible“Donut Hole”
CoverageGap
Total Spending
≈ 95%
80% Feds Pay Reinsurance
15% Plan Pays
Catastrophic Coverage
Federal Government Pays
75% Plan Pays
25% out-of-pocket5% out-of-pocket
Private plan Pays
$630 $3,610Consumer
Out-Of-Pocket
$310
Total consumer out of pocket = $4,550
$2,830 -$6,440$310-$2,830
Post-Reform Medicare Part D Coverage:
The Donut Hole in 2010
$0- $310
$ +
Consumer Pays
Deductible“Donut Hole”
CoverageGap
Total Spending
≈ 95%
80% Feds Pay Reinsurance
15% Plan Pays
Catastrophic Coverage
Federal Government Pays
75% Plan Pays
25% out-of-pocket5% out-of-pocket
Private plan Pays
$630 $3,610Consumer
Out-Of-Pocket
$310
Total consumer out of pocket = $4,550 - $250 rebate = $4,300
$2,830 -$6,440$310-$2,830
$250
Post-Reform Medicare Part D Coverage: The Donut Hole in 2020 (generic)
$0- $310
$ +
Consumer Pays
Deductible“Donut Hole”
CoverageGap
Total Spending
≈ 95%
80% Feds Pay Reinsurance
15% Plan Pays
Catastrophic Coverage
Federal Government Pays
75% Plan Pays
25% out-of-pocket
5% out-of-pocket
Private plan Pays
$630 $3,485Consumer
Out-Of-Pocket
$310
Total consumer out of pocket = $4,550
$2,830 -$6,440$310-$2,830
Total consumer out of pocket = $4,550
$3,610
75% Plan Pays
25% out-of-pocket
80% Feds Pay Reinsurance
15% Plan Pays
Catastrophic Coverage
5% out-of-pocket
75% Plan Pays
25% out-of-pocket
$2,830 - $17,270
Post-Reform Medicare Part D Coverage: The Donut Hole in 2020 (brand-name)
$0- $310
Consumer Pays
Deductible“Donut Hole”
CoverageGap
Total Spending
≈ 95%
80% Feds Pay Reinsurance
15% Plan Pays
Catastrophic Coverage
Federal Government Pays
75% Plan Pays
25% out-of-pocket5% out-of-pocket
Private plan Pays
$630 $3,610Consumer
Out-Of-Pocket
$310
Total consumer out of pocket = $4,550
$2,830 -$6,440$310-$2,830
Total consumer out of pocket = $2,143
$1,203
- $7,643
50% ManufacturerDiscount as TrOOP
25% out-of-pocket
25% Plan Pays
