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Senator David Vitter.Recent healthcare reform legislation gradually reduces what beneficiaries must spend when they reach the Part D doughnut hole or gap in coverage. Medicare consumers who hit the doughnut hole receive a 50 percent discount on brand name drugs and a 7 percent discount on generics in 201While that's good news, don't breathe any sighs of relief just yet. Seniors and the disabled who hit the doughnut hole must still spend ,448 in total drug costs in 2011 before they reach catastrophic coverage period..Over the past four years, TSCL's surveys have found that about 9 out of 10 people receiving Social Security benefits report that their household spending rose by at least per month during the prior year. But that's just the tip of the iceberg. "Retirees need to plan for large monthly jumps in spending annually over the course of their retirement," Johnson says. In every year since 2014, the largest percentage of those people participating in TSCL annual Senior Surveys reported that their household spending jumped by more than 9 per month. Since 2014 annual COLAs grew a total of just 3.5 percent, averaging less than 0.9 percent per year. One factor in why retirees have such a gap between their COLA and spending is the consumer price index that the government uses to measure inflation and to determine the annual boost. "One would think that the CPI used to calculate COLAs for retirees would be based on seniors' spending patterns, but it is not," says Johnson. Instead, the COLA is determined by the growth in the Consumer Price Index for Urban Wage Earners and Clerical Workers. Younger working adults spend a far smaller portion of their income on medical costs, which is the fastest growing category of the CPI in most years. On the other hand, younger working adults spend more on transportation and gasoline, categories that have gone down dramatically in recent years. "This tends to understate the inflation experienced by the majority of people receiving Social Security," notes Johnson..Wall Street economists are in the midst of a growing debate over whether we are in for "the return of inflation.".While Part D costs are not capped, there is a "catastrophic level" of coverage that kicks in once Part D enrollees spend ,000 of their own money out-of-pocket. Five thousand dollars is just the threshold in 201That threshold is forecast to rise to more than ,000 per year in just eight years. Even worse, the ,000 threshold is just for your covered drugs under Part D. It does not include other out-of-pocket spending for Medicare, such drugs you may receive through Medicare Part B, and all other out-of-pocket costs..Senate Returns to Washington.One witness, Scott Serota, President and CEO of the BlueCross BlueShield Association, suggested a gradual shift from the current fee-for-service system toward a series of new payment models that would allow for geographic variability. Another witness, David Bronson, President of the American College of Physicians, suggested a patient-centered medical home model, where each patient would choose a physician with a specific team of caregivers. He explained that his model would result in better coordinated care for seniors..Creating a new minimum benefit for low-income retirees set at 25% above the poverty line ;.Physicians have another medication at their disposal for treating diabetes after the Food and Drug Administration has now approved a new long-acting insulin product derived from the established drug Lantus.