Medicare Plan D
Every time medical science has a great advance, either the government or corporate business interests screw it up. Every time. Flu vaccines get made. Government doesn't order it or prepare for its availability. AIDS drugs show promise. Pharmaceutical companies charge outrageous prices gouging into the emotions of the dead and the dying. Regulations in medicine have done more to curb the rights of the patient-doctor relationship than the excesses of the abusers. That of course leads us to Plan D Medicare. In case you have been living in a cave recently, the feeble-minded amongst the population (AKA Congress) has decided to start prescription drug plans for Medicare patients. Except for the following "glitches" I guess it has been a major success:
Of the top 4 above, my favorite is Number 4. Get this: When you enroll in a plan you are locked in for one year. The insurance company, though, can change the drug benefits with a 60 day notice. If they change the drug benefit, you still cannot change plans. Funny, I did not think that Jack Abramoff was in the insurance lobby business also. Who paid whom off to get this one passed?
Imagine- you spent 5,325 hours choosing the right drug plan based on your medication profile. One month later, after Insurance Company X lured you into signing up, they send you a letter and tell you that your drug Savemylifenow Sodium is no longer covered. But the good news is you can stay in their plan and get their flashy 4-color preventive medicine brochures.
I don't know, but where I come from we call that a bad deal. I would think that if you are locked into a program for one year then the insurance company should guarantee the plan for that year. Duh. It would sort of be like colleges charging tuition and 60 days into your last semester raising the tuition $100,000.00.
Number 3 is pretty ridiculous as well. You would think that to protect the public interests, all companies must offer at least 2 drugs in each class of drugs. No so. Some plans have absolutely no choices in entire classes of drugs. For example, if you have Medicare and Medicaid and were admitted to long-term care- a real possibility, one plan (available to residents at a known long-term facility in New York) covers NO intravenous antibiotics. None. What's a few deadly bacteria among friends anyway?
Another plan (a different one) that covers some intravenous antibiotics does not cover ANY Alzheimers medications. Presumably you can get your life saved by Timentin (antibiotic) but they are not going to let you know that your life was saved because you can't get your Aricept.
Yet a third plan covers no antidepressants but does cover antipsychotics. So after you are treated for schizophrenia you then are aware of your disease and get depressed. No drugs for you now. Go directly to a hell, do not pass GO, do not collect medications. The list and the inconsistencies go on and on.
While it seems reasonable to analyze plans based on the drugs you are on today, the real issue is the drugs you will be on tomorrow. Congress appears to have allowed companies to be approved vendors without specific guidelines on what constitutes basic and reasonable coverage.
Once again, our lawmakers have acted with the courage of the cowardly lion in Wizard of Oz. But that makes sense because they also have no hearts and certainly no brains.
Dr. K
Related Topics: Choosing the Right Care, Financial Planning for Caregivers
Technorati Tags: medicare, PlanD, prescriptioncoverage
- While you can analyze a plan on the Internet, most elderly do not have this tool
- The plans are uber confusing and downright deceptive
- Private companies offer plans that are so different in price and drugs that the entire Applied Mathematics Department at MIT refused to choose their own plans due to the mathematical improbability of a correct choice.
- The rules the insurance companies play by are not the same one as you need to play by.
Of the top 4 above, my favorite is Number 4. Get this: When you enroll in a plan you are locked in for one year. The insurance company, though, can change the drug benefits with a 60 day notice. If they change the drug benefit, you still cannot change plans. Funny, I did not think that Jack Abramoff was in the insurance lobby business also. Who paid whom off to get this one passed?
Imagine- you spent 5,325 hours choosing the right drug plan based on your medication profile. One month later, after Insurance Company X lured you into signing up, they send you a letter and tell you that your drug Savemylifenow Sodium is no longer covered. But the good news is you can stay in their plan and get their flashy 4-color preventive medicine brochures.
I don't know, but where I come from we call that a bad deal. I would think that if you are locked into a program for one year then the insurance company should guarantee the plan for that year. Duh. It would sort of be like colleges charging tuition and 60 days into your last semester raising the tuition $100,000.00.
Number 3 is pretty ridiculous as well. You would think that to protect the public interests, all companies must offer at least 2 drugs in each class of drugs. No so. Some plans have absolutely no choices in entire classes of drugs. For example, if you have Medicare and Medicaid and were admitted to long-term care- a real possibility, one plan (available to residents at a known long-term facility in New York) covers NO intravenous antibiotics. None. What's a few deadly bacteria among friends anyway?
Another plan (a different one) that covers some intravenous antibiotics does not cover ANY Alzheimers medications. Presumably you can get your life saved by Timentin (antibiotic) but they are not going to let you know that your life was saved because you can't get your Aricept.
Yet a third plan covers no antidepressants but does cover antipsychotics. So after you are treated for schizophrenia you then are aware of your disease and get depressed. No drugs for you now. Go directly to a hell, do not pass GO, do not collect medications. The list and the inconsistencies go on and on.
While it seems reasonable to analyze plans based on the drugs you are on today, the real issue is the drugs you will be on tomorrow. Congress appears to have allowed companies to be approved vendors without specific guidelines on what constitutes basic and reasonable coverage.
Once again, our lawmakers have acted with the courage of the cowardly lion in Wizard of Oz. But that makes sense because they also have no hearts and certainly no brains.
Dr. K
Related Topics: Choosing the Right Care, Financial Planning for Caregivers
Technorati Tags: medicare, PlanD, prescriptioncoverage
9 Comments:
I chose AARP's drug plan for my elderly father, since they cover 95% of brand name drugs out there, and they have low premiums. I didn't bother to look at the other 20 plans I could have chosen from, since most only covered 80% of the brand name drugs available.
It's not right that a plan can change its formulary with 60 days notice, but you can't change your plan but once a year.
The worst part of this Medicare Part D mess is that nearly all the information about choosing amongst plans is on the Internet, but too many elderly people don't/can't use computers. Shame on Medicare.
I have Lupus and Stills Disease (among others), and I'm on disability. I take 15 drugs regularly, including the very expensive DMARDS/Biologics. I went online, thinking it would be easy to pick a plan, just as Medicare had implied. ("No matter how many drugs you're on, no matter how expensive they are, we guarantee you will find a plan that meets your needs!") It was rediculous. When I had questions and tried to contact Medicare, I would be on hold for 3 hours waiting for a "real person"... That "real person" knew NOTHING about the plans they were pushing! One had the nerve to say, "Because of Hurricane Katrina, our staff has been redirected to help the gulf coast Medicare recipients. The Medicare Part D plan is the LEAST of their worries! You should feel lucky!"
The plan I ended up choosing was equally as difficult to contact. "ring ring... thank you for calling xx, due to high call volumes, we are unable to assist you. Call back in a few weeks when we have a better handle of the new Part D coverage" Excuse me?
It has been a nightmare, to say the least.
I love your blog! It's really interesting.
Thank heavens I have secondary insurance. I am on disability and so have Medicare and my husbands insurance as secondary as he works for a company that has less than 100 workers (Medicare's rules). I didn't realize how bad this plan D is. I am very happy that my step-father has his Veteran's and they pay for everything and that my mother is very healthy at 71. I didn't have to go into Medicare's drug plan because my husbands insurance is much better. I hit my deductible in May of last year and for the rest of the year my drugs were paid for. I take 12 medications a day. I knew by the news reports that Medicare's part D was having problems but I didn't realize how much of a mess it was or how really unfair the plans are. Do you like how they have all the Hollywood stars touting the Medicare Plans? Like they're somehow supposed to be more believable or something. Thank you for your most informative and well written blogs, Dr. K.
Great comments- I thank you...
Medicare should be dismantled in its entirely. The disdain that the Medicare system has for the patients on Medicare is montrous. 3 hours on hold? Hurricance Katrina??? What was last year's excuse.
We should force all of Congress to go on medicare as Primary and Medicaid as supplementary- that should be a wake up call.
Dr. K.
Dear Doctor K. you are preaching to the choir here. Where do we go to get our voices heard? Do you know that our country has outlawed mercy killings with good medications and bedside last rites in order to allow our senior citizens the dignity of dying in agony while the Congress members have access to all the health care that is possible. I know that only in a perfect world would every one be able to get the health care they need promptly and thoroughly, but in an improved world, health care would have three tier clinics. A preventive clinic, a treatment clinic and a critical care clinic. These would be as numerous as convenience stores and banks, A hospital would be like hospice for end of life care and convenience to family. The prevention clinics would be the ones that would see the most people, the treatment clinics would have equal amounts of trained staff as the critical care clinics and together they would serve all the people all the time, without cutting into the pockets of the Doctors, or the patients. The lawyers would be the only losers because malpractice cases would be unheard of unless a doctor deliberately set out to hurt some one because of malfeasance. That would meant the support staff would know their right leg from their left leg on a patient and would have time to double check because they would not be backed up serving people who waited until they were critical, waiting 10 hours in the Emergency room for treatment for what used to be a minor scatch, that could have been treated at preventive care level with an antiseptic ointment and bandaid, and now needs amputation due to diabetic condition. If you are mentally out of breath, it was designed to read that way. Our emergency rooms are now doing preventive, treatment, and critical care all at the same time so some stock holder can line their pockets and claim healthcare management is saving money and lives. Do you trust our system? Only if you do not have to use it, would you be safe. I agree, let the managedcare advocates use the system they have created
As a retired teacher, I am entitled to State Health Care as secondary insurance with medicare as primary.
I have been enrolled in UHC HMO at a fairly reasonable price. My co-pay for my 12 prescription meds runs anywhere from $20-$45. My DH's takes about 8 prescription meds.
My choices through the state were to select a Plan D or have my monthly rates for insurance tripled.
Since there is a cap on the amount
of money available to pay for drugs, it is cheaper for me to pay triple the amount for insurance w/o part D than to select any of the plans available.
Whose is looking out for the consumer? Certainly not the drug companies, the government or the health insurance plans!!!
mn said...
I took a training course to help our elders choose a plan good for them. Each day I pray for the wisdom to choose the right one for whoever enters my office. One gentleman choose an HMO only to find out the expensive drug will be available for 6 months, then he must pay out of pocket I guess until the following year. Also, he received a 90 day supply, but had to pay the copay like it was 3 30 day supply. The chap is 94 years old and doesn't need this stress at his ripe old age.
I delayed signing up for the Part D program because from the beginning I knew it would be a disaster. The administration of the program was given over to private insurance companies - this ensures that they will make lots of money and the consumer will get lots of hell. I got a letter from Health & Human Services stating that if I did not sign up with a plan on my own, they would sign me up with one, because I qualify for "extra help" paying for the costs. I didn't want THOSE morons making my decisions for me so I immediately picked a plan, signed up, and the day I received the letter from the plan I chose, I received a letter from the plan with whom DHHS assigned to me. They did not wait for me to make a choice. They sent a letter, dated TWO DAYS later than the first letter, and had signed me up with some company of their choice. So I am now signed up with two different plans and have to make fifteen phone calls to stop one of the plans and to make sure everyone at each place is doing their jobs correctly and that I get a written copy of every single thing that is done.
Yesterday my doc gave me a prescription for Fosamax, a very expensive med, and I am not sure either plan will cover it. I had no idea that I was going to have to take this med. If the plans do, it will surely change because of the jaw deterioration controversy. I have spastic paraplegia, severe arthritis, osteoporosis, IBS, excruciating muscle spasms and chronic severe pain aggravated by certain medications, over-activity and weather fluctuations. Neuro damage has given me bladder spasms, muscle atrophy in my forearms and hands, and some hearing loss. I checked the side effects of Fosamax, and spoke with about 75 people who take it. Of the 75, 66 experience moderate to severe joint & muscle pain. I have enough of that now = I need more like I need an extra eye in the middle of my forehead. I am only 44 years old, and today I might as well be 84. Having to now deal with the BS of Medicare and all that it entails, fighting with them about coverage of a drug that will save my mother's eyesight (but they don't give a damn - they don't cover it - why? "Because" - that is the reason. "Because we don't cover it". *scream*) I am ready to tell them I don't want any drug coverage from them AT ALL. I am drafting a letter to the president regarding the whole assinine experience with this program, the problems my parents are having with it, and those of my elderly neighbors as well. I will copy it to every congressman and senator if I have to do so. I am SICK of this crap. When the people who make the laws have to deal with Medicare in order to get their own medical treatments and get them paid for, that is when it will change. Until then, expect nothing from them, as they have the best healthcare available and it is all for free - our tax dollars pay for it. Put them all on an HMO now, and when they retire, they should have to go on Medicare/Medicaid or whatever their state offers. The stuff will hit the fan then.
Last year, Humana charged me $7/mo. This year, $15. Their website showed $3.xx for Cialis
(15 Jan,07). They charged me $12. I'm not paying. Half the info I need is not available on their website. Customer Service ( all very nice people ) can never get me to the people who make decisions ( CS can't ). The people who make decisions never get back to me. Communication is done by phone or snail-mail. I get recordings I can't respond to, and my mail ( much of which is misdirected by a postman with dyslexia or ADD - I'm not exaggerating ) involves cycle times of weeks. Reminds me of the Italian movie about the guy who needed a legal document and went from one office to another to another, half of whom said they weren't the right office. I think he ended up destroying one of the offices. Good idea.
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