Joan, a Medicare beneficiary, has Crohn’s disease with an ileostomy, cardiac dis

Question

Joan, a Medicare beneficiary, has Crohn’s disease with an ileostomy, cardiac disease with four stents, chronic interstitial cystitis, diabetes, generalized osteoarthritis with cervical and lumbar spondylosis, and is status post unilateral knee replacement. In August, Joan entered the doughnut hole. Why? How can Joan get out of the doughnut hole? According to the article by Neuman and Cubanski, is Joan’s case unusual? According to the article by Neuman and Cubanski, is Joan likely to get out of the doughnut hole?

Explanation / Answer

Doughnut hole means the insurance coverage gap i.e.diffrence between the coverage required and coverage acquired.

Joan entered doughnut hole because his coverages were not adequate as per his medical requirements. Now Joan can get out of doughnut hole by joining a government-subsidized prescription-drug benefit offered by private insurers and pharmacy benefit managers. As per the article, the steep increase in enrollment & premiums for government-subsidized prescription-drug benefit programs indicate that Joan case is not unusual. Now enrolling in this above mentioned program, there is a good probability of Joan getting out of doughnut hole if he has chosn the program wisely depending upon match of the plans avilable and his specific need.

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