By Frank Frisch

I found out the hard way recently that I was not well-informed regarding the infamous Medicare “doughnut hole.”

When I went to pick up my medications at a local pharmacy, I was told that one of my monthly medications — and normally co-pay $28 with my insurance — was going to cost me $268.99. I have a heart condition and, quite frankly, I thought I was going to have a heart attack when I discovered that I was in the infamous “doughnut hole” — which I had never heard of before that moment.

I since have learned that some Medicare Part D prescription drug plans have a coverage gap, which is also referred to as the doughnut hole.

Various Medicare D prescription drug plans have left many of us retirees not fully realizing the impact of this doughnut hole.

We are shocked to find out about the Medicare doughnut hole at our pharmacy when our co-pay surges from what we paid the previous month.

Although some states offered more than 40 different plans from which to choose, we enrollees ended up not fully understanding how our individual plan would work.

Many of us are shocked when we hit the Medicare doughnut hole and are unsure how we got into the hole or when we will come out of it.

Medicare Part D providers are required to mail monthly statements so that we can see what has been used up. It is difficult to grasp, even with a monthly statement, unless you completely understand how your plan works.

Here’s what a friend and fellow senior citizen recently explained to me:

“As far as the ‘doughnut hole’ is concerned, the drug coverage stinks. Hope you don’t need hospitalization. My wife has been in and out of the hospital four times in less than two years, causing me to think about moving to Siberia. She has diabetes, high blood pressure, Alzheimer’s, takes about 17 pills daily, and I can’t get out of the doughnut hole. You think you have it bad? I know the frustration of the various phone calls, waiting and waiting for all the menus to go through, but I am thankful I still have my wife. I do not see the light at the end of the tunnel, especially if the new health plan is approved. Glad I’m 82 plus years old, as I will not have to put up with all the mess that is going on in Washington. Keep the faith.”

For standard plans, enrollees pay their co-payment until their total drug cost reaches $2,700. In the initial coverage phase, the enrollee pays a co-pay amount and the drug plan pays the rest of a discounted drug price. The total drug cost is the co-pay amount paid by the enrollee, plus the amount paid by the Medicare Part D drug plan.

After $2,700 in total drug costs are reached, there is a gap in coverage — the doughnut hole — and the enrollee must pay the full cost for their prescription drugs until they have paid $4,350 out of pocket.

After total true out-of-pocket (TrOOP) expense equals $4,350, enrollees reach “catastrophic coverage” and their cost per drug drops to a small co-pay. During the period enrollees are in the coverage gap or doughnut hole, they must still pay their monthly premium.

When I reached the doughnut hole, I became very anxious and depressed and was unable to sleep because I knew that I could not afford to pay retail prices for my medication, which totaled about $754 monthly. Before the doughnut hole, I was paying about $80 in co-pay a month using my Medicare Part D coverage insurance.

I considered just stopping my medications, just as many folks did when about 3.4 million Part D enrollees reached the coverage gap in 2007. I spoke with two nurses about the effects of me going “cold turkey” without my meds. Both said that I would most likely suffer a stroke or even death.

I discovered that 64 percent of enrollees taking medications for Alzheimer’s disease reached the coverage gap in 2007, as did 51 percent of those taking oral anti-diabetic medications, as well as 45 percent of patients on antidepressants.

Now we are hearing about the proposed national health care reform. There are both pros and cons regarding it. We are now further confused as to what is best for us seniors.

Who is lying to us or telling us half-truths? The extreme right, or the extreme left? Perhaps both? We would appreciate your comments on this issue.

And pray that you do not fall into the doughnut hole.

Frank Frisch is a retired resident of Middletown.