Talk:Donut Hole (Medicare)

From Wikipedia, the free encyclopedia

This is the talk page for discussing improvements to the Donut Hole (Medicare) article.
Please sign and date your posts by typing four tildes (~~~~). Put new text under old text. Click here to start a new topic. New to Wikipedia? Welcome! Ask questions, get answers. This is not a forum for general discussion about the article's subject.	Be polite Assume good faith No personal attacks Be welcoming	Article policies No original research Neutral point of view Verifiability

Contents 1 Neutrality 2 Table 3 $5100? 4 I'm confused

[edit] Neutrality

I like the recent descriptive additions to this page, but they venture more into explanatory editorial territory than fact based Wiki-style writing. I'd like to keep the basic content if it can be either re-worded to be more objective, neutral and fact-based. Jargent 14:52, 27 November 2006 (UTC)

I took out the bit about the donut hole "rationalizing" costs, since its ridiculous, and no one in god's green earth would argue that discouraging taking needed medication (described here as 'wasteful') is a sound health policy. The reality is that a number of people fit rather neatly into the donut hole (which is at 3850 for the year 2007), having chronic illnesses that require expensive drugs, but NOT expensive enough to hit over the required donut hole gap. I find it telling that medicares own "tip-sheet" regarding gap coverage is simply to buck up and pray that someone else can help with your expenses. SiberioS 17:52, 29 March 2007 (UTC)

I still think that peice on cost rationalization is worthwhile for inclusion because it's the government's official stance. Regardless of personal beliefs here, the government's perspective is a valid one if only because they implemented the policy. If we can find good citations re: the drug usage of individuals in the donut hole, that would be good to throw into the Criticisms section. In general, these citation should be easy to find. Jargent 17:04, 11 April 2007 (UTC)

Why is it valid to call it rationalization if the government is the one that came up with it? That sounds like assuming that what the government says is automatically rationalization, and that's hardly objective. Don't get me wrong, I would call it rationalization too, but that's do to my personal experiance working under medicare. We do need some good, objective references for that. 206.213.251.31 19:51, 26 June 2007 (UTC)

[edit] Table

I appreciate your efforts and the entry is getting clearer. However, I think the table is too cluttered.

I made up that table because I thought the narrative description was too difficult to understand. I based it on a graphic in the New England Journal of Medicine.

Now that you've added those additional columns, I can't easily understand it any more. I watch a lot of Powerpoint lectures, and in the jargon of Powerpoint, it's too busy.

I was trying to make a simple point, that at different levels of payment, the patient pays different amounts and Medicare pays different amounts. Now, I really had to think for a few seconds to figure out what the chart was doing -- and I created it myself.

It took me a while to find what TrOOP stood for, and it took me longer to figure out what True Out of Pocket meant. I realize the significance of the patient's cumulative spending, but it makes it more difficult for the reader to figure out the simple explanation of payment levels.

I also understand the temptation to include the names of the different levels -- deductible phase, initial coverage phase, donut hole, and catastrophic phase. But (except for "donut hole") these are bureaucratic jargon. It doesn't help the reader understand the concept any better to know that when their bills go over $5,100, the government calls it a "Catastrophic phase."

I think the table would explain things better, and be simpler, if you took out the column headed "Phase name" and the column headed "TrOOP". As Walter Gropius said, "Less is more."

You could put the Donut hole row in a different color -- say, make the table white and the donut hole grey (or bold). Then you could say in a caption at the bottom, "The donut hole is in grey."

Thanks for your efforts anyway. I'm going to have to find that New England Journal of Medicine article, because they may have taken their own graphic from a graphic in a government document in the public domain, and that would be even clearer than the table. Nbauman 18:31, 11 April 2007 (UTC)

I understand the less is more thought. They're bureaucratic jargon, but I'm in the industry so they're beaten into my head.

I'll drop the level name, but I think there is a value in keeping TROoP in there... it distinguishes between how much the gov't pays and how much the patient pays. Some patients won't care that the donut hole kicks in at $3600 in total drug spend, what matters more is that it kicks in when they've paid $750 of their own money. I'll try to make it a little more clear.

A graphic would be good too, the only downside being that it'll be more difficult to update the figures for following years. The numbers included are already out of date. Jargent 19:00, 11 April 2007 (UTC)

Thanks for the update. I couldn't figure out how to get the gray myself.

I still think the TrOOP column makes it too complicated. The very concept of the different contributions at different levels is pretty complicated, if you don't deal with it all the time. The TrOOP column gives you another element of the design to figure out before you understand the table. Nbauman 23:06, 11 April 2007 (UTC)

[edit] $5100?

Could we find something to support the $5100 figure? I've worked with these plans professionally since the privetization and I've never seen this figure come up.

The gap begins after the $2400 tde cost is met and ends once $3850 trOOP is met. This isn't the same thing as $5100.

For instance, it you have $1200 medication with a $200 copay, you'll be in the gap on your second fill, with only $400 towards the $3850. If you get the med twice again (paying full price), you'll have paid $3200, so your trOOP will be $3200. On the next fill you will pay $650 (the amount remaining between the 3200 and the 3850) and 5% of the remainder (5% of 550 is $27.50), namely, $677.50. Add this into our trOOP total and you have 3877.50, which doesn't relate to 5100 at all. Even if you don't add in the 5% amount (since it's really after the gap) you don't get anything that relates to it.206.213.251.31 19:50, 26 June 2007 (UTC)

[edit] I'm confused

If they're having to pay for everything, how can they be said to "have" medicare coverage? —Preceding unsigned comment added by 64.122.63.142 (talk) 14:40, 7 April 2008 (UTC)