Supporters wanted all beneficiaries to get some initial benefit from the program, and they wanted to protect those with overwhelmingly high costs. The resulting compromise led to the doughnut hole.
Under Obama's health care law, the gap will be gradually phased down by 2020.
This year, the law provides a 50 percent discount on brand name drugs and 7 percent break on generics. Next year the discount on generics rises to 14 percent. When the changes are fully phased in, beneficiaries will still be responsible for their annual deductible and 25 percent of the cost of their medications until they reach catastrophic coverage.
If Republicans succeed in repealing what they dismiss as "Obamacare," the discounts would be wiped out as well.
Joan Gibbs thought her pharmacy had made a mistake. Her total cost for a brand-name painkiller in the doughnut hole came out lower than her co-payment earlier in the year, at a time her plan was picking up most of the tab.
"I reluctantly called the insurance company," said Gibbs, 54, who lives near Cleveland. "If they had made a mistake, I knew they would catch it sooner or later. I was very surprised that it turned out to be such a good discount."
Gibbs is on Medicare because of an auto-immune disorder and other medical problems that left her unable to work.
Other beneficiaries say it's still a struggle, even with the discounts.
John Robinson of Bel Air, Md., has diabetes and heart problems. A retired director of patient accounts for a hospital, Robinson said he runs up his credit card balance to pay for insulin, other medications and diabetic supplies in the doughnut hole.
"Thank God for credit cards," said Robinson, 71. "I thought it was better this year, but it still cost me more money than I had."
Medicare plan finder: http://tinyurl.com/2c6o5fh
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