Health Conditions A-Z Endocrine Conditions What Is Type 2 Diabetes? Diabetes and Medicare: One Patient's Story By Karen Pallarito Karen Pallarito Twitter Karen Pallarito tells stories grounded in science and backed by solid reporting. As Senior Conditions Editor for Health, she covers COVID-19 plus umpteen other health and wellness topics. Her freelance portfolio includes pieces for The Washington Post, U.S. News & World Report, Working Mother, Westchester Magazine, and the news syndicate HealthDay, among others. Karen started her career as a health policy reporter in the nation's capital, where she covered congressional hearings on Medicare and Medicaid. From the late 90s to the early aughts, she reported on health business for Reuters Health and contributed to its medical and consumer health newswires. Prior to that, she was Modern Healthcare's New York Bureau Chief. A fellow of the Association of Health Care Journalists' 2019 class on Comparative Effective Research, Karen is committed to helping people understand the benefits and harms of clinical interventions and exposing racial/ethnic disparities in healthcare. When not on deadline, you might find her whipping up something in the kitchen, working out, bingeing on cable news, or indulging in some form of mind candy (aka reality TV). health's editorial guidelines Published on February 29, 2016 Share Tweet Pin Email If you have diabetes and are on Medicare, you may encounter a "doughnut hole" that has nothing to do with sugary goodness. Although 2003 legislation created Medicare Part D to pay for prescription drugs, there is a gap in coverage known as the doughnut hole that occurs when the federal government stops paying for drug purchases as an annual limit is reached. Once a patient hits that limit, the government picks up the tab again only after the patient has spent thousands of dollars. Dick Robbins, 72, who lives in Hot Springs Village, Ark., discovered this after he reached his reimbursement limit in 2007. "It's a financial burden—part D Medicare doesn't cover a heck of a lot of the stuff I use, they only cover part of it," said Robbins while he was in the doughnut hole. "Now I pay full price for everything I take." Robbins is taking metformin and two types of insulin, Novolog and Lantus. The medication and syringes are costing him up to $300 a month with Medicare's help and up to $800 a month when he has to pay it all himself. My feeling is, one of the villages in America is missing its idiot, and he's working for this health-care company. —Dick Robbins, Type 2 Diabetes Patient His part D health-care provider only allows him to fill one-month supplies of medication, and he once got dangerously close to running out of insulin. His doctor had verbally upped his prescription without increasing the dosage at the pharmacy. Following his doctor's new instructions, Robbins ran out of medication a day early and had to convince his provider to authorize his prescription for the next month in advance. How the Costs of Type 2 Diabetes Can Add Up Blood glucose test strips alone can cost a dollar each. (Read more) "Last month I was down to one shot left and I called my part D provider and said, 'Look it's going to cost more to take care of me if I don't have the insulin than it does to pay for the insulin.' So they authorized the insulin," he says. "My feeling is, one of the villages in America is missing its idiot, and he's working for this health-care company." Resources to manage costs If you are on Medicare and have limited income and resources, you may qualify for extra help paying for your prescription drugs. For more information, go to the "Getting the Help You Need" section of the online publication Medicare & You 2008. If you don't have prescription drug coverage, you may qualify for free or low-cost prescriptions. The Partnership for Prescription Assistance, a pharmaceutical industry-sponsored initiative, can tell you more. The American Diabetes Association has more about coverage of diabetes costs by Medicare, Medicaid, and private health insurers. Was this page helpful? Thanks for your feedback! Tell us why! Other Submit