Indeed, out-of-pocket spending on health care services is exploding, especially for drugs.

But it did lead to "significant reductions in out-of-pocket spending" for many government workers and retirees.

The $18.92 amount he pays will be counted as out-of-pocket spending to help him get out of the coverage gap.

The $40 will count as out-of-pocket spending and help you get out of the coverage gap.

But those payments would not count toward the $3,600 limit on out-of-pocket spending.

Another issue is the high level of out-of-pocket spending.

Total out-of-pocket spending on health care rose $12 billion, to $212.5 billion in 2002.

Some 25% of out-of-pocket spending by individuals is for prescription drugs.

The problem is even worse for people in poor health, whose out-of-pocket spending has increased 140 percent since 1999, the report says.

But costs paid by an employer are not counted as out-of-pocket spending.