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Healthy Skepticism Library item: 3260

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: news

Medicare mess
NorthJersey.com 2005 Dec 27
http://www.northjersey.com/page.php?qstr=eXJpcnk3ZjcxN2Y3dnFlZUVFeXkxNCZmZ2JlbDdmN3ZxZWVFRXl5Njg0NDEzNw==


Notes:

Ralph Faggotter’s Comments:

“ The way the law was written, the federal government is forbidden from negotiating lower prices with drug manufacturers. “

Why on earth would you pass a law like this?

In any other country, the taxpayers would be screaming blue murder!


Full text:

Medicare mess
Tuesday, December 27, 2005

THIS month, millions of older Americans are signing up for Medicare D, the prescription-drug program that Senate Majority Leader Bill Frist, R-Tenn., hailed two years ago as “a red-letter day for seniors.”

At this point, Medicare D looks more like a red-letter day for the pharmaceutical companies that produce the drugs and the health-care insurers administering the program. The estimated cost for Medicare D is pegged at $724 billion over the next decade – with pharmaceutical companies and the insurers reaping much of the largesse.

The way the law was written, the federal government is forbidden from negotiating lower prices with drug manufacturers. The result: A survey released recently by the non-partisan group Families USA found that the best Medicare D plan prices are nearly 50 percent higher than prices negotiated by the U.S. Department of Veterans Affairs.

What’s more, the penalties imposed on seniors who do not sign up for a new plan by May 15 compel many to sign up, whether they want to or not. Since 40 million Americans are on Medicare, that’s quite an influx of lucrative new business.

But a glaring injustice for seniors is that Medicare D is a complicated mumbo jumbo of plans and jargon like “formularies” and “doughnut holes” that can leave just about everybody scratching their heads. In North Jersey alone, 17 health-care providers offer 45 Medicare plans to choose from, and which ones are best for you could take more studying than a month of final exams.

Put simply, it is a good thing that most people on Medicare are retired, because learning about the new drug plans can be a full-time job. To make an informed decision, you need to read everything you can on the subject, attend free seminars typically given by insurers at senior centers and assisted living centers, talk with your pharmacist and current insurer, visit the medicare.gov Web site, and – in a pinch – even call Medicare itself at (800) MEDICARE.

Heaven knows there’s plenty to digest and to consider:

· The biggest flaw with Medicare D is that seniors in poor health and taking many medications have the most difficult and confusing choices to make. Who looks out for elderly people who lack a sharp mind or who have no family member or advocate who can tackle the arcane angles of Medicare D? The federal government is spending hundreds of billions of taxpayer dollars for this?

· Seniors with large prescription-drug bills should probably sign up for a plan immediately – after doing all that homework. Once they enroll, they will be able to change plans during an open enrollment period each year from Nov. 15 to Dec. 31. This is especially worth noting if a senior’s list of medications changes.

· Seniors with rock-solid retirement prescription-drug plans through their employer should count their blessings. They can likely avoid the madness known as Medicare D without penalty. All other seniors need to take a crash course in the subject.

· Healthy seniors without solid prescription-drug plans through their employers will probably want to sign up for minimal coverage next May 15, when penalties begin to accrue. The next time they can sign up is during the Nov. 15 to Dec. 31 open enrollment period. The penalties are 1 percent of the cost of the premium per month. Those who wait, say five years, until they take more medications will pay 60 percent more per month for whatever coverage they ultimately buy.

· Low-income and moderate-income seniors should check to see if they qualify for added assistance through New Jersey’s Pharmaceutical Assistance to the Aged & Disabled program or the Senior Gold program. Call (800) 792-9745 for more information.

· Everyone needs to compare Medicare D plans. Each plan has a different set of drugs that are covered, different co-pays, different premiums and, in some cases, different pharmacies or mail-order drug companies that will accept them. The list of drugs that a person takes is called a formulary, and seniors have to compare plans to see which plans cover which drugs.

· Even savvy seniors with an Internet connection may be daunted. Although medicare.gov has several online programs to help consumers choose the best Medicare D plan, the Web site is not particularly easy to navigate and – for seniors with dial-up modems – too slow to be of much use.

· Figuring out their formulary online can be tough unless seniors know precisely what drugs they take. Example: Type in “glyburide,” a common medication for diabetes, and you will be asked whether you want glyburide, glyburide micronized or glyburide/metformin HCL.

· Beware the doughnut hole. In their finite wisdom, members of Congress set up Medicare D so that all plans must cover, to some extent, annual prescription-drug costs up to $2,250 and above $5,100. Reimbursement for expenses between $2,250 and $5,100 is non-existent. If seniors pay a lot more than $5,100 a year for prescription drugs, they’ll likely want to pay more for a supplemental plan that covers the so-called doughnut hole costs.

If all this sounds like migraine material, that’s because it is. And the irony is that this is the result of efforts to shift Medicare away from a federally administered program to one that relies on the private sector.

From what is evident so far, the red tape and confusion spawned by the bureaucracy in the nation’s capital can’t compete with the mess born of the privatized Medicare D.

Copyright © 2005 North Jersey Media Group Inc.

 

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