Publication Date


Document Type

Masters Thesis


School for Social Work


Medicare, Medigap, Pharmaceutical services insurance-United States, Older people-Pharmaceutical assistance-United States, Elder, Senior, Geriatric, Medicare Part D, Donut hole, Coverage gap


When Medicare Part D was unveiled in 2006 one controversial feature was the inclusion of a coverage gap which potentially forced enrollees to pay thousands of dollars out-of-pocket. This thesis asked the question: How has falling into the donut hole affected seniors' views and feelings of health insurance and government, and how has this experience informed their sense of civic engagement? Two hypotheses were presented at the outset of this qualitative study. The first was that since seniors are a particularly active demographic they would respond to the donut hole experience with some kind of political action. The second supposed the opposite might be true: since the donut hole policy is potentially stigmatizing, seniors would react to it by experiencing themselves as powerless in the face of a large system. Initially the goal was to interview twelve seniors who had fallen into the donut hole, but because of recruitment difficulties only two seniors were interviewed. This researcher interviewed two health insurance experts to enhance the data. The major finding was that of the two hypotheses, the second comes much closer to describing the felt experience of seniors. Respondents described feeling powerless and resigned to their fate in the donut hole. Another major finding was that the role of social workers has proven important in helping seniors avoid the donut hole. A major implication of this finding is that social workers should closely monitor their older clients' health insurance statuses as well as the ever-changing regulations governing insurance rules.




iv, 64 p. Thesis (M.S.W.)-Smith College School for Social Work, Northampton, Mass., 2010. Includes bibliographical references (p. 51-53)