Talk:Medicare Part D coverage gap

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): C.sou, Lisa nel, Nlc48070, Tinajeromr, Dddttt111.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 03:47, 17 January 2022 (UTC)

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 piece 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)

It seems like a good solution would simply be to state clearly that the government provides that explanation. It does not need to be phrased that the rationalization is fact; but it is an objective fact that the government presents that argument, and it probably should be stated in the article. Omgoleus (talk) 15:46, 23 March 2010 (UTC)

Table

I've updated the table for 2018 and tried to clarify the headers. Lisa nel (talk) 03:54, 6 November 2017 (UTC)

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)

$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)

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)

Wow!

Surprised me! —Preceding unsigned comment added by 148.177.1.215 (talk) 13:46, 8 January 2009 (UTC)

Title change and copyediting

I've just moved this article from Donut Hole (Medicare) to Donut hole (Medicare) because my quick review of websites using this term, starting with Medicare.gov itself (see "MPDPF: Glossary: Coverage Gap", indicate that it is not a proper noun. I've also done some copyediting to reduce the excessive capitalization in the material apparently taken from Medicare documentation (which tends to capitalize every Term of Interest) down to Wikipedia's standard sentence case.

Regular readers of this article might want to consider that this article possibly should be titled Coverage gap. Even though "donut hole" is in common use, I suspect it's nearly always mentioned at least once as "coverage gap", even in articles and documents that say "donut hole", whereas the reverse may not be true, and it seems to be the offical name of the phenomenon. ~ Jeff Q (talk) 19:15, 31 March 2009 (UTC)

What is CMS...???

Under the Details section, the following is stated - "The first $750 of TrOOP comes from a $250 deductible phase, and $500 in the initial coverage limit, in which CMS covers 25% of the next $2000", however, CMS is not defined anywhere within the article that I can see. It is customary to provide the full definition of an acronym upon first usage when writing to provide the reader who is unfamiliar with an understanding of what the acronym refers to. A reference explaining what CMS is is needed here.

Howaboutyouthinkaboutit (talk) 06:21, 15 November 2009 (UTC)

'CMS' stands for Centers for Medicare and Medicaid Services (http://www.cms.gov/) and is part of the U.S. Department of Health and Human Services (http://hhs.gov)

RonMcK3 (talk) 02:57, 10 June 2010 (UTC)

confusing article, full of political opinions

I have to say that this is about the worst wikipedia article I have ever read, confusing, full of bias, over use of acronyms. Surely someone can write a far better one which actually explains the topic, which I do not have the time to do. Trudyjh (talk) 19:02, 18 November 2009 (UTC)

The "catastrophic coverage threshold"

The one glaring non-neutral term I saw was the use of the phrase "catastrophic coverage threshold."

This expression seems a bit too sensationalist and dire -- why not just take out the word "catastrophic" and leave it at that?

--Erredmek (talk) 05:30, 23 June 2010 (UTC)

Because that's the official term used in CMS and plan documentation. Annorax (talk) 05:19, 4 July 2010 (UTC)

Explain Catastrophic

Maybe the government definition of catastrophic should be explained. Note that a person taking six different drugs (which is not unusual for an elderly person) may be catastrophic or not depending on how many of those drugs are generic. If 4 of the 6 drugs are non-generic, that person will fall into the coverage gap very quickly. If all 6 drugs are generic, that person will never fall into the gap.--72.87.182.181 (talk) 18:00, 13 May 2015 (UTC)

Clarification on Intro / Citation needed?

The intro states "...copayments made by the consumer up to the point of entering the gap are specifically not counted toward payment of the costs accruing while in the gap."'

Can I get a cite to confirm that those copayments made prior to entering the gap period don't count? Mononymous (talk) 16:15, 14 July 2016 (UTC)

Article Improvement Goals

I think we should merge the sections of 2018 Medicare Part D payments and "Standard Benefit Design" since they pretty much say the same thing. Lisa nel (talk) 03:55, 6 November 2017 (UTC)

Hello,

As a part of the Wikipedia project conducted by UCSF School of Pharmacy CP133 (Health Policy) Course, the following members plan to improve this article by adding the following information:

Introduction: More background about the ACA - before and after part D → jose

Details: Add up-to-date figures in the chart → connie

Add information to phase out section -> nicole

Impact on Medicare Beneficiaries: “This section needs to be updated. In particular: it does not reflect benefit changes following passage of the Patient Protection and Affordable Care Act of 2010. Please update this article to reflect recent events or newly available information. (September 2017)” -> Lisa

Phase-out: More details on the phase-out plan by 2020 → Denise

Peer Feedback: Neutral Point of View

Overall, the edits made by the pharmacy team reflected a neutral point of view throughout the changes, despite medical coverage being a debatable topic and information can be biased. Information from sources were accurately stated and all data and statistics were written as intended from its sources. However, it is possible that some readers may feel that the editor is criticizing this "donut hole" gap in Medicare Part D since they do provide a lot of information on its shortcomings and how the ACA is trying to resolve it. Since we are healthcare providers, it's natural for us to side with the patient-care aspect and want to promote the best medical benefits for patients. If possible, adding a comment on why such a gap in coverage exists and what were the financial benefits of that decision would enhance the neutral point of view of this article. Perhaps it would raise taxes or take away different services for these patients.

Drake

In conclusion, the edits made by this group was neutral and provided clear and detailed explanation of what the coverage gap is, its impact on patient expenses, and what the ACA has done to cover that gap. I can confidently say this article was enhanced by these edits and will be a valuable resource for patients who may be confused with this gap in their care.

Drake — Preceding unsigned comment added by Dimsumdrake (talk • contribs) 06:13, 7 November 2017 (UTC)

Peer Feedback: Plagiarism

STUDENT 4- Is there evidence of copyright or plagiarism? if so, specify...

After checking the content written and the sources linked; the information is the same, however the information is concise and summarized from a number of resources for the most part. One part of the edit that I would caution is under the section 2018 Medicare Part D Standard Drug benefit; the first line "For 2018, the standard benefit includes a deductible of $405 (the amount that beneficiaries must pay out of pocket before their insurance benefits kick in) and a 25% co-insurance up to the initial coverage maximum of $3,750. " seems very closely to the cited article in KFF. Please compare: In 2018, the Part D standard benefit has a $405 deductible and 25% coinsurance up to an initial coverage limit of $3,750 in total drug costs, followed by a coverage gap. While it is directly not word for word. I feel weary that it is too closely worded. At the same time, I understand that these numbers and facts are objective information and there isn't a ton of way you can word this. Overall, I like the costs summary table; it really summarizes the secondary sources for readers and makes it easier to understand the complication of the Medicare part D coverage gap. Overall, there is minimal signs of plagiarism, I think my peers did a great job updated this wiki page; the information is easy to understand and summarized for the lay audience compared to some of the secondary sources that this information was extracted from.

Danh Danhvd (talk) 02:38, 8 November 2017 (UTC) 18:25, 9 November 2017 (UTC) — Preceding unsigned comment added by 128.218.42.181 (talk)

Peer Feedback: Overall Goals

I feel that the group achieved their overall goals for improvements on adding more background of the ACA, updating the charts, impact of medicare beneficiaries. Especially for the low income subsidy and phase-out sections which were straight to the point easy to read for viewers. AustinW426 (talk) 06:23, 8 November 2017 (UTC)

Peer Feedback: Cited Secondary Sources

STUDENT 2 – Are the points included verifiable with cited secondary sources that are freely accessible? If not, specify…

The citations of the pharmacy group were indeed verifiable with secondary sources that were freely accessible. (The only citations missing were one that were of past contributors). While the wording and paraphrasing was not taken well by the wiki community, the citations were all in order. They did a really good job in using sources that were not only accessible, but also (really great) without compromising the credibility of the sources. The first citation source is the best where they cited CMS or "Centers for Medicare and Medicaid Services" which is where the most reliable information about medicare exists. What is really great about this source is that, the wiki page sifts though and explains the CMS website allowing for readers to understand and get a more basic understanding of (in the very least, the terms of) Medicare Part D, and then readers, if they need to sign up or find forms on CMS, are navigated and understand what much of the denser information may mean when they visit the site. Additionally, citing and referencing much of the government websites is extremely beneficial to the reader who may not have been able to find the correct information but also providing a source of contact and contact information too. In addition, the quality of the edits was done well in that they were concise which is key to wiki articles. Changes that can be made would be to make the sentences a little clearer however, such as, "From this point now until 2020, brand-name drug manufacturers as well as the federal government will be responsible for providing subsidies to patients in the doughnut hole," to maybe cut extraneous phrases like into "From 2017 until 2020, brand-name drug manufacturers and the federal government will be responsible for providing subsidies to patients in the doughnut hole."

Sahar Sprinklerose (talk) 07:39, 7 November 2017 (UTC)

— Preceding unsigned comment added by Danhvd (talk • contribs) 18:43, 9 November 2017 (UTC) 

Peer Feedback: Style

Student 3 - Sean Overall, the writing was done well, I think with a few minor edits it will be superb. Some of the sentence wording can be changed slightly to improve flow and make it more concise. For example: "In 2010, the Affordable Care Act began providing a $250 rebate check for individuals whose drug expenses took them into the doughnut hole in an effort to close the coverage gap." Could be written as: "In an effort to close the coverage gap, the Affordable Care Act of 2010 provided policy for individuals to receive a $250 rebate check." Not a huge deal, just something to think about in regards to writing style. The group did a good job of catering to the audience, I know nothing about Medicare Part D and I completely understood everything they wrote. There may be a few words that people of less educational background may not understand, but may be up to your discretion (I understood it!). Citations were done properly, and organization was sound. Sean Seanlew9 (talk) 02:45, 8 November 2017 (UTC)