Editor's Notes:

While talk about the gap in Medicare Part D coverage, the infamous "doughnut hole" where seniors pay 100% of their drug costs out of pocket up to $3600, has kicked into high gear, it seems not to have become the political firestorm that critics expected.

Even with the doughnut hole, most beneficiaries are better off financially than they were before the drug benefit was created, when many seniors had to fend for themselves all year long.

[CMS Administrator Mark] McClellan said seniors in the coverage gap should continue to use their Medicare drug cards to get the prices negotiated by their plans. They also can apply for prescription-assistance programs run by many states and pharmaceutical companies, he said. And they can call Medicare at 800–633–4227 for information and help.

"There are lots of places to go to get lower–priced drugs, to get additional help with your drug costs," he said.

Mark Merritt, president of the Pharmaceutical Care Management Association, stressed that the majority of seniors will not reach the gap. Many who will could delay it by more than two months by switching to generic drugs and using mail–order pharmacies, he said.

"There's been a lot of hand–wringing about it and very little information about what people can do to stay out of it," said Merritt, whose organization represents companies that administer drug benefit programs for employers and health insurance carriers.

Another thing seniors can do is choose their drug plans more carefully for 2007 when the open enrollment period begins Nov. 15. Susan Knight, director of the Senior Health Insurance Program in Anne Arundel County, said she and other workers will begin visiting centers and programs for seniors next month, the start of what is likely to be another major marketing season for companies offering prescription coverage.

When the 2007 enrollment period for Part D begins in November, seniors who faced significant out of pocket costs this year can shop for plans that cover drugs with no lapse in coverage in return for somewhat higher premiums or co–pays. 2006 has been a trial period for the drug benefit, and everyone—seniors, Medicare administrators, and insurers, should be in a much better position to navigate the program next year.

Ideally, however, the next Congress should take up the issue of far reaching Medicare reform—by, for instance, offering seniors means—tested and risk–adjusted vouchers for the purchase of private health insurance. Sicker, poorer seniors could pick plans that covered prescription drugs and disease–management programs. Healthier and wealthier seniors could invest in HSAs or other consumer directed plans. Closing the doughnut hole for seniors is one thing—closing the doughnut hole in the federal government's entitlement programs will require much more bold thinking on Medicare than we have seen to date.