AGNEW — President Bush signed the Medicare Act of 2003 on Dec. 8, 2003. It provided a prescription drug benefit for Medicare recipients.
They would pay a monthly premium for coverage to help them buy prescription drugs.
But the plan included a complicated gap in the coverage that has come to be known as the “Medicare Part D doughnut hole.”
Donna and Grover Stark of Agnew fell into that hole abruptly in mid-August, and it’s going to take them a lot of time, effort — and money — to get out.
The Starks were profiled in a Seattle Times story — that appeared in newspapers across the country — highlighting a situation faced by between three million and seven million seniors across the country.
In Washington state, that figure could be as many as 214,000, although exact figures are impossible to determine since many seniors may not buy enough prescription drugs to be affected.
Couple must wait
For a higher premium, the couple can avoid the “doughnut hole ” by switching to a different plan, but they have to wait for the open enrollment period, which begins Nov. 15, and coverage wouldn’t take effect until Dec. 29.
In the meantime, the couple wonders how they are going to pay the mortgage and other bills.
“We’re deciding how we’re going to live for the rest of the year,” Grover said.
Both the Starks have had heart attacks and suffer from chronic congestive heart failure.
Donna also suffers from emphysema and Grover from arthritis.
In the past year, the couple’s drug regimen had reached 23 separate prescriptions totaling $2,000 a month: $1,394 for Grover and $704 for Donna.
The couple lives on Grover’s $2,200 monthly railroad pension. They had also taken out a line of credit to pay drug costs, but that has since been maxed out.
They thought the new Medicare Plan D would solve their problem — until they hit the doughnut hole.
Plan great at first
The first enrollment period for one of 70 prescription drug plans was between Nov. 15, 2005 and May 15, 2006.
Cheri Brudevold, the Starks’ daughter, said when the deadline was approaching, her parents didn’t understand what they were supposed to do.
So the couple attended an informational seminar that was hosted not by State Health Insurance Benefit Advisors volunteers but by an insurance agent, said the family.
The Starks signed up for a prescription drug plan called Coventry AdvantraRx.
“It was great at first. I just paid for the Lipitor and it cost me $20,” Grover said.
But then the Starks unexpectedly hit the doughnut hole and discovered the next $2,850 worth of drugs — each — was on them.
“We were doing really well. Now we visit the food bank,” Donna said.
Their daughter said, “They weren’t told and they’re not the only ones. We’re just now figuring it out.”
The details of the doughnut hole vary depending upon which of the myriad plans a person chooses.
But under the standard annual coverage, in addition to a monthly premium a person pays a $250 deductible, then 25 percent of the next $2,000 in drug costs with Medicare paying 75 percent.
Once a person’s drug purchases total $2,250 — the $250 deductible plus $500 out of pocket and $1,500 from Medicare — he or she enters the doughnut hole.
Coverage now quits and drugs cost full price, until the person has paid another $2,850 in the same year for total out-of-pocket expenses of $3,600.
Once that total is reached, Medicare pays 95 percent of a person’s prescription drug costs for the rest of the year.
The person has safely reached the other side of the doughnut hole.
Collecting donations
The couple’s daughter said when her parents’ drug coverage unexpectedly stopped in mid-August, they were so upset that her sister-in-law Meg Stark contacted the State Health Insurance Benefit Advisors.
“It is overwhelming for us, much less them,” Meg said.
Then an employee at Seattle based National Asian Pacific Center on Aging in Seattle saw the Seattle Times article and contacted the Starks.
“They are working on something as they speak. There’s nothing for them yet. We’re collecting donations and hopefully stay positive,” said Robert Stark, the couple’s son.
The couple can sign up for a new prescription drug plan during the open enrollment period that begins Nov. 15 and ends Dec. 31 but the coverage won’t kick in until Dec. 29.
After learning that his parents’ had no prescription drug coverage for the next several months, Robert tried to get a loan to cover the expenses.
When that was unsuccessful, Robert took a day off from his job at Sound Transit in Seattle, where he lives during the week, and traveled back to his home of Port Angeles to set up a donation fund.
Donations to the Donna and Grover Stark Prescription Fund can be made at any Washington Mutual branch.
Robert said he hasn’t had time to check the fund balance but through last week it had enough to fund his parents’ prescriptions through September.
“I’m scrambling for October and then if things still are not OK, I’ll start lobbying for November. I don’t expect a lot, but every little bit helps,” Robert said.
He also has received permission to “pass the hat” at Sound Transit’s next staff meeting, Robert said.
After his parents’ story appeared in the Seattle Times, it “went national,” showing up in newspapers in Oregon, California, Arizona and Ohio, Robert said.
“It’s spread all over. The fund wasn’t set up until after the articles ran. It’s a damn shame,” he said.
Telling his parents’ story has helped make people aware of the problem across the nation, Robert said.
“People need to know, this brings it out,” he said.
The Starks even received a note of encouragement from Bob Oliver of Palm Springs, Calif., who read the story in the Aug. 31 edition of the Desert Sun.
“There’s some really wonderful people in these United States that don’t even know my parents and yet want to help. It’s amazing that so many people care,” said their daughter.
“When you work hard all your life, you should be able to live comfortably,” she said.
“If this helps my parents, that’s my goal. It’s important to let people know because there’s so many affected,” she said.
