LAKE STEVENS — The math is pretty simple.
When Jack Holden has prescription drug coverage through Medicare Part D, he pays about $45 a month for his medications.
But when he hits the “doughnut hole,” where coverage stops, he pays nearly $350 a month.
“When you’re living on Social Security of $1,354 a month and pay rent of $650, that doesn’t leave much for the other stuff,” said Holden, who is 66.
For Holden, the gap in coverage begins at $2,930 in overall prescription drug costs. For about $2,000 worth of expenses, it’s all on him.
“You have to reach $4,900 to become part of their program again,” he said. “All that has to take place in one year. Every year it starts over.”
Holden’s most expensive prescription is for non-synthetic insulin for his diabetes. “When I’m not in the doughnut hole, I only pay $4 for insulin every 21 days,” he said. When he hits the doughnut hole, he said the cost jumps to $265.
The federal Affordable Care Act calls for the out-of-pocket costs during the coverage gap to be reduced over time for both brand name and generic drugs for those on Medicare’s prescription drug plan.
By 2020, the doughnut hole would be closed and seniors typically would pay 25 percent co-pays on both brand name and generic prescriptions. In Washington, more than 60,000 people use Medicare’s prescription drug plan.
Holden said he doesn’t know how he would have managed without the extra help provided in the bill.
“I absolutely cannot make it by paying for it and still even be able to eat, let alone drive a car, get to my doctor’s appointments or anything else,” he said.
Holden said he lost his house after taking out a second mortgage to pay for medical bills. His wife was diagnosed with cancer and died about a year ago. “It just wiped us out,” he said. “I had to declare bankruptcy.”
He’s now living in a 650-square-foot apartment, part of a senior housing complex in Lake Stevens.
To raise some money, he sold his equipment and tools from the car repair business he operated for 27 years. “I’m to the point where I’ve pretty much sold everything I have to be able to afford my medicine,” he said. “In another year, that will all be gone.”
Holden said he expects to spend about five months in the coverage gap this year before regaining coverage during the last six weeks of the year.
“This is a medicine that you have to have,” he said. “You can’t survive without it.”
Sharon Salyer: 425-339-3486 or salyer@heraldnet.com.
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