Will the Supreme Court Reopen the Donut Hole?

The Editors | June 13, 5:22 pm

If the Supreme Court strikes down the health care law later this month, Congress will likely feel intense pressure to set aside party differences and preserve some of the law’s popular provisions that have already gone into effect.

One of these provisions closes the so-called "donut hole" in the Medicare prescription drug program, a coverage gap that has required seniors to pay for all of their own drugs out of pocket when their annual costs fall between certain limits.

The graphic above explains exactly what the donut hole is, and how the health care law implemented a series of gradual reductions in the share of costs paid by the beneficiary until the gap is closed fully in 2020. Seniors who would have been in the donut hole are expected to save $562 each this year, an amount that will rise to $1,322 per year in 2020.

Current law provisions to close the donut hole would be preserved if the Supreme Court upholds the health care law or if it strikes down only provisions associated with the individual mandate to purchase health insurance.

Read more at CQ.com: The Full Effects of a Full Reversal

About the Data

The data on changes under the health care law comes from the Department of Health and Human Services. Individual savings are here, and the schedule of rate reductions is here. Figures for the deductible, initial coverage limit and catastrophic coverage limit are from the Kaiser Family Foundation.