Medicare Drug Plan

By Ruth Dunagan

 Headline from various news stories such as “Don't let Medicare prescription drug plans become a prescription for uncertainity,”  “Dealing with Medicare drug benefit problems,”  “The States step in as Medicare falters”  and “Medicare Misery,”  are just a few of those out there and they pretty much tell the same story of a mixture of worry, confusion, and frustration. 

 Several states have stepped in with emergency funds so that their poorest and most helpless citizens will not be deprived of their medications while these problems are struggled with.  The states are hoping that the Federal Government will repay them, but Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, said he did not have the authority to reimburse them.  He urged states, pharmacists and providers to work with his agency to collect from the insurance companies administering this program.  Additionally the states are required to subsidize this federal program over which they have very little oversight!

In talking with people who are working with the program, the best thing that was said was , “This is a good program, but there is no way all the eligible people in this nation can be enrolled in one month.”  Other comparisons included, “a train wreck,”  and several things that they assured me would be unprintable.  And everyone I spoke to was working extra hours trying to get the problems solved.

Another problem that some of you may not be aware of is the “doughnut hole.”  You pay a $250 deductible and then a 25 percent co-pay on the first $2,250 of drug benefits each year, plus roughly another $450 a year in premiums.  So if your prescriptions cost $2,250 a year, or about $190 a month for prescriptions, you pay 1,200 a year and the plan pays $1,050.   But then, Coverage disappears until you have spent about $3,100 out of pocket.  Coverage reappears after a total of $5,100 in prescription costs.

Many seniors will never get the coverage because they won't sign up and many of those who do will not be able to pay enough out of pocket to qualify for needed benefits.  Even with seniors being short changed, the plan is expected to add over half a trillion to federal budget over the next decade.

One administration goal, running the program through the private insurance industry, conflicted with a clear, cost-effective plan.  Seniors must evaluate innumerable plans, each with differences in costs and benefits that make the program even more confusing and raise total costs because each plan tacks on its own profit.  And that explains why the insurance companies were lobbying so hard for it!

The second goal, fattening the drug industry, prohibited the government from negotiating bulk price discounts from drug companies as Veterans hospitals do.  According to a study by Families USA, drug prices obtained by the VA are at about 48 percent less on average than those expected to be charged to the people enrolled in the Medicare drug program.  Among the 20 most widely prescribed drugs for seniors is Protonix and Zocor.  Protonix costs the VA $253 and the seniors $1,080. and Zocor costs the VA $251 and seniors $1,323.

Should you enroll?  If you do not have an insurance plan that pays on your prescriptions, I would think that you would enroll.  And here are some things you should consider.

F If you currently have retiree coverage, check with the administrator to make sure that signing up will not conflict and make you lose it.

F If your annual income is less than $14,355 ($19,245 for married couples),  you may be entitled to financial assistance and should call the Social Security Administration at (800) 772-1213 to find out if you are eligible.

F If you are on Medicare and Medicaid both, you should have been assigned to a prescription-drug plan that became effective on Jan. 1.

 Obviously, we are stuck with this for now, but let's think about what we need to tell our legislators:

F  Repeal the ban that prevents the federal government from negotiating the best price for drugs.  (Oops, that would cut into the profit of the drug corporations)

F Simplify the program by reducing the number of plan options for each state ( Cimarron County has 17 plans and I doubt that any one covers all medications!)

F Or get the insurance companies out of it and cut out the fees they are tacking on.  Make it a true plan for Seniors instead of corporations!  (Are you aware that 60 % of the corporations in America pay NO income taxes)

F  If they insist on keeping the insurance companies involved then they should make the full list of medications offered by each plan publicly available along with any drug plan rules that restrict their access.

 Eliminate the “doughnut hole.”

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