Medicare drug plan a medical maze

[Charlie Brown]

http://www.ajc.com/news/content/news/stories/1105/06medicare.html

Reuben, 84, who was a sailor in World War II and an engineer for 40 years, designed conveyor systems for automobiles before retiring at age 70. Claudia, 66, a registered nurse, is a retired insurance claims adjuster who knows how to slash through red tape.

Even so, the Becks fear they have met their match in Medicare's new prescription drug benefit plan, designed to help seniors pay for medicine.

"It's just so confusing," Claudia Beck said. "And it seems the more I call, the more runaround I get."

Medicare is the government program that provides health insurance for Americans 65 and older. It has not previously covered outpatient prescription drugs.

But in 2003, Congress passed a law that will make prescription drug coverage available to those on Medicare starting Jan. 1.

Private insurers are providing the coverage. Those eligible for the benefit can pick an insurance plan from dozens being marketed to them. Seniors generally will pay premiums and co-payments as with most insurance policies.

But the confusion begins right at the beginning — when seniors try to pick a plan. In Georgia, there are 82 plans offered by 18 companies.

Even after comparing premiums, co-payments, deductibles and rosters of drugs, the work will still not be complete. Seniors will also need to determine how they'll stomach what's termed "the doughnut hole" — a gap where there's no coverage after seniors rack up drug costs of $2,250.

[asjr]

1. During that gap when they get no coverage they

will still have to pay the monthly premium of between 32$ and 35$ a month . This "assistance" bill is a boondoggle of the first degree. Seniors are damned if they do and damned if they don't. I wish they would scrap it.

[bobbieinok]

3. $32 to $39 a month???????

[ikojo]

14. Remember that this is on top of the regular

Medicare premium which goes up to around $80 a month in January.

[Sal Minella]

2. More than 100 plans available to confuse people in Illinois -- and after

seniors struggle through finding which ones actually carry their meds, and narrowing that down to which ones carry their meds at the best prices, we all need to remember that the companies offering the cards can CHANGE THEIR PRICES and CHANGE THEIR ROSTERS OF MEDS OFFERED overnight without warning their patrons this is going to happen.

The new Medicare Drug Act is a wonderful success as a boondoggle for Big Pharma, total disaster for the people who need drug coverage.

[leQ]

7. talk about a trainwreck waiting to happen, i'm jus glad i'm not a

pharmacist. i tried wading through it last week and got 'call us back in two weeks, we'll know more then' for the last 2 weeks. so i'll see what the excuses are this week.

[Chicago Democrat]

8. Everyone I know is just skipping it...

Either they are on Medicaid, in which case, the state pays anyway. Or they are on medicare and have medigap policy that covers drugs anyway....


This 'plan' is going nowhere, it needs to be scrapped.... now.

[ikojo]

15. Once a person commits to a Medicare drug

carrier he/she must stay with that carrier for one year. So, while the insurance company can arbitrarily change its formulary, the patient is stuck.

[lcooksey]

4. What a disaster

Every member of Congress who voted for this horrible plan ought to have to sit down with at least 10 elderly constituents and help them try to pick out a plan. I've spent probably about 24 hours doing research for my parents so far, and we still haven't accomplished much. Most of the plans don't even have all their info available yet.

[SharonAnn]

5. And for those not well educated, or cognitively challenged - which

would be a much larger percentage than the general population, they're having a very difficult time.

My dad, a retired surgeon, is 88 an in early-mid stages of Alzheimer's disease. He can't understand it at all but he tries to. He's almost been in tears a couple of times because it doesn't make sense to him. Well, it actually doesn't make sense but that's another story.

He asked "why can't it be like Medicare?". I told him that Medicare is a Democrat developed program and the Rx drug plan is a Republican developed program. they have different objectives. Democrats wanted to help people and Republicans wanted to help drug companies.

I reminded him that he was against Medicare when it was being voted on in the 1960's and that he voted for Bush and the Republican Congress.

Still, our elders don't deserve this.

[Radio_Lady]

9. In Oregon, under the Senior Advantage HMO plan, we have to take

the Kaiser Permanente pharmacy plan, or we lose the medical coverage completely. The documents came in last week. No choices here; end of story.

The new complicated plan is a big rip-off. The only people who gain are those in the pharmaceutical industry, IMHO. Nothing new here -- it's a Republican plan. We'll just have to live with it. What are the options?

[classof56]

11. Well, at least we still have assisted suicide.

Sorry--don't mean to sound flip and unconcerned, but I am convinced that this administration cares less than nothing about any of us who are Medicare-eligible and the sooner we exit the earth, the better they like it. And with Kaiser--sorry, but from my experience with KP in the past and family members' current experience, the medical care they provide is so lacking that your chances of adequate diagnosis and care is practically nil. Where I'm located and the retirement plan I'm on gives me another year to make the perilous journey into the new Medicare pharmacy jungle, but after that, I seriously fear for my future medication needs.

Maybe a Democratically-controlled Congress will fix this terrible situation. Until then, God help us all!

Tired Old Cynic

[Radio_Lady]

16. Well, I have to put my faith in the doctors at Kaiser, even though

I have had my trials and tribulations with them. I am scheduled for (hopefully) minor surgery on 11/10/05 and just hope it isn't with a guy like the one they profiled on Page 1 and subsequent pages in the Portland Oregonian on Sunday! Yikes!

I've actually had good luck with MOST of the Kaiser doctors. I know it's not the best care I've ever received, but not the worst, either. I also have to be grateful that I'm not one of the 45 million people who have NO COVERAGE at all.

We are totally up in arms about the path the Republicans have taken us down. All we can do is get active for Democrats during the coming election years and hope for the best.

I'm not a tired old cynic yet. I find that making a lot of noise, confronting any mistakes (which recently resulted in a favorable solution to a neglected problem), researching any medical conditions on the internet and getting as much information about the individual doctors -- helps me in navigating the system.

Good luck with your retirement issues!

In peace,

Radio_Lady in Oregon

[Mnemosyne]

13. What a nightmare! I've been researching for my Mom

and still feel like I have no clue how to advise her.

Any tips? :)

Thanks!
V

[Trillo]

6. "confusion" is a red flag.

The well-obfuscated lie.

[Radio_Lady]

17. Here is a web site which helps you compare plans:

I'm not saying this is easy, but it is a place to start. They have side-by-side comparisons for each state.

http://www.medicare.gov

Then you can select plan choices. On that page, you'll find a link for Medicare Personal Plan Finder. STEP #1 asks if you have both Medicare parts "A" and "B" -- you need both to join the Medicare Advantage Plan or to buy a Medigap plan. STEP #2 takes you to a Personal Care Finder screen that asks for your ZIP to check off benefits you're interested in. Three selections are Medicare Advantage Plans or Original Medicare or Medigap. Then you can "Find
A Plan" in your area. Special needs plans are also included.

Perhaps I've helped -- or not -- depends on what state you are in, etc. etc.

In peace,

Radio_Lady

[WePurrsevere]

10. It's for the disabled as well & you're penalized if you DON'T sign up...

or are late signing up.

My husband and I are both disabled and on Medicare. We don't usually take conventional meds right now and quite frankly we can't afford to have another chunk taken out of our SSD... Medicare's Plan B premium is outrageous enough.

We both resent feeling like we're being coerced into accepting one of these plans NOW when we don't normally need them right now and if we're lucky we won't for another couple of decades. (Alt health modalities work rather well for us so far, knock on wood, and they're not covered by Medicare.)

If the government REALLY wants to help us with Rx drug coverage then cut out all the song and dance, make free (for the cost of Medicare it should already be included imo) and make it one simple plan that covers ALL Rx drugs with a $5.00 to $10. co pay. Trying to figure out not only which plan is right for you NOW but which plan you MIGHT need in the future is just plain insane. They need to either simplify it a LOT or ditch it and start from scratch WITH Seniors and Disabled working with Congress, etc to develop a truly helpful plan.

[ngGale]

12. "Happy New Year" from * - NOT!

If you have Medicaid/Medicare...January 1, Medicaid will no longer pay for your Rx. A plan has been chosen for you, only nobody knows yet what that plan is. Dual recipients will suffer the worst, especially if you live in low-income housing. Everything is based on your income, all of sudden - your income is in question. Your choice is, buy Rx, live in the street, or die. Food stamps will also be cut because * says, you can afford food now that you have his wonderful Medicare Drug plan.:sarcasm:

Heat relief goes, too. I figure, 90 days tops, people will start to die. :cry:

God, I hate these people! (Forgive me, but thanks to * and his minions, I now know what hate is.):nuke:

[lonestarnot]

19. Usual pick on the weak, old and feeble.

[zann725]

18. Medicare ALSO covers the Disabled on SSDI. And most of those

are DEFINITELY above the yearly income level (by only about $1,000), preventing them from even SOME of the CURRENT "breaks" in prescription drug prices that regular Senior Medicare recipients are entitled to...due to slightly lower monthly income.

SSDI Medicare recipients are NOT eligible for Drug Discounts UNTIL they pay over THREE thousand, FIVE hundred dollars in med costs. Then the "catastrophic" clause ALLEGEDLY kicks in, and a more substantial discount applies. Given that Rumsfield owns substantial pharmaceutical stock/ownership...as a Senior or Disabled, I would think TWICE or THREE TIMES before accepting ANY drugs at a "significant" discount...as neither of these demographics (receiving SS and SSDI) are among those that the Neocons want to receive "entitlements" beneifts too long, if at all As visions of "Constant Gardener" come to mind...