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Medicare Gap

Medicare Gap

According to Medco Health Solutions sources, the results of a sample survey on Medicare members have revealed that, most of them do not understand the gap in the coverage plan covered under their Part D coverage.

The sample survey was conducted through 1000 survey respondents, out of which 62% have confirmed that they have not understood the concept of the plan, and 28% of them have said that there was no understanding of the entire plan. Therefore more than two-third of the members are unable to identify the areas wherein they need to bear expenses on their own.

As per the 2008 calculations, if a patient's drug costs touch $2510, the patient is required to bear the entire costs until the costs reach $3850. From here on, the coverage starts working once again. However, it is quite unclear to maximum participants of Medicare how this calculation is done.

Moreover, these gaps and limits keep on increasing with each passing year, although the patients neither understand the reasoning behind this gap nor do they understand the rising expenses behind the plan.

The CMO at Medco, Mr. Woody Eisenberg has expressed that majority of Medicare members are definitely aware, that there are gaps in the coverage, but they are not be able arrive to identifying the gaps as there are multiple points of confusion there.

It was also clarified that this gap in coverage was anticipated to cause a lot of confusion after Medicare Part D came into effect in 2006. And hence the Center for Medicare and Medicaid services have taken care in explaining the gap to the members. However, individual patients have still not been able to identify the extent of the gap in monetary terms.

During the course of the survey, it was found that 39% of the members who were in the gap had received complete information regarding the gap and was completely aware of it. 26% of them said that they had received no information and 27% said that the materials explaining the gap were confusing.

More than 75% patients who have hit the gap are being treated for one chronic ailment.

Direct Analytics have conducted the survey through random telephone calls, with funding through Medco.


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