Women with Dementia and Diabetes at-risk of Reaching Doughnut Hole

Posted on July 7, 2010


A new study discussed in an article in HealthDay News reveals that women with Medicare who have dementia and diabetes are most likely to reach the coverage gap of their Part D drug plan. The coverage gap is when someone who has a Medicare Part D plan becomes responsible for the full cost of their drugs. This gap is also known as the doughnut hole.

This multi-state study done by the Journal of General Internal Medicine found that 16 percent of 287,000 Medicare enrollees entered the coverage gap. Three percent of those enrollees entered the gap in the first 180 days of the year. The study goes on to find that only seven percent of those enrollees who entered the gap ever got out of it and qualified for catastrophic coverage. Catastrophic coverage occurs after someone has spent a fixed amount of their own money on drugs and can now come out of the coverage gap. Their medications will now be covered at a significantly reduced cost.  

After women with dementia and diabetes, people with Medicare who are most likely to fall into the coverage gap are people who have end-stage renal disease, coronary artery disease, chronic obstructive pulmonary disease, mental health conditions and congestive heart failure.