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WHAT YOU HAVEN'T READ ABOUT THE NEW MEDICARE DRUG PLAN

By Frank Kaiser

First, know that this new drug plan, despite its name, is private insurance in which Medicare plays no role. In fact, its main purpose is to kill Medicare as we know it.

It lacks all the virtues of Medicare: reliability, clear national standards, automatic enrollment, and clinical decision-making left in the hands of doctors and patients.

Instead, Plan D includes massive corporate welfare, increases your premiums, offers no benefit stability, confuses the hell out of everyone, and was enacted under an ethical cloud.

If you're a vet, you're lucky. Stay with your drug plan. The same goes for most corporate retirement health plans.

But if you have no drug coverage, regard Plan D the perfect storm of spending the treasury dry, taxing your pocketbook to new limits, and creating the most perplexing scheme since John wrote Revelations.

Consider:

Medicaid Eliminated for Seniors — About 5.5 million seniors on Medicaid will be shifted automatically to Part D coverage on Jan. 1, a tidy windfall for the insurance companies. Many will face potentially catastrophic consequences. Life-saving medications may not be covered. Doctors and hospitals may have to be replaced. Our most vulnerable — nearly 4 in 10 have mental or cognitive impairments —will be thrown into a pool of sharks.

  • This year's 13.2 percent jump in the Medicare premiums coming on top of last year's record 17.4 percent increase, raises grave questions about its painful effect on millions of older and disabled Americans living on fixed incomes.

Elimination of Patient Assistance Programs — Companies like Bristol-Myers Squibb, Merck, and Johnson & Johnson, sensing the potential saving of some $4-billion a year, are telling Medicare-eligible drug recipients that unless they are turned down by insurers — hardly likely, it would illegal — they are no longer eligible for coverage, not even when the patient hits the catastrophic $2,850 out-of-pocket "donut hole."

  • Boston University School of Public Health estimates that 61 percent of the estimated $850 billion in Medicare dollars used in Plan D's first 10 years will remain with drug makers as added profits. That's a whooping $519-billion windfall for Big Pharma, courtesy Bush & Co.

Death of Drug Company Discount Cards — Lilly, Pfizer, GlaxoSmithKline, Novartis and others now offer medicine for as little as 12 bucks a month to moderate-income seniors. Already Lilly has notified 235,000 seniors that its program, Lilly Answers, will end next May. All others are expected to follow.

  • Among the many atrocities hidden in this 700-page bill is a cap on the use of general revenues for Medicare. This will create a phony crisis in about four years leading to cutbacks in Medicare-covered hospital and doctor care, as well as drug benefits, significantly increasing your out-of-pocket costs.

Quantity Limits on Drugs Create Barriers to Access — Many plans impose quantity limits to restrict the duration of treatment or limit the monthly dose for cholesterol-lowering statins, antidepressants, angiotensin II receptor antagonists, proton pump inhibitors, ACE inhibitors, osteoporosis and Alzheimer's medications. Often plans require that a patient first try a cheaper drug. Remember too, drugs not covered and bought at full price outside your particular plan are not counted toward the deductible.

  • If Congress had considered your interests at all, Medicare's prescription drug benefit would be a nationwide benefit with standard premiums, cost-sharing structure and lower, negotiated drug prices.

You're Locked In, Insurers Aren't — Even if you're fortunate enough to find an insurer that covers all or most of your drugs — Lots of luck! — after May 15, you can't change insurers until the following November. At any time, however, your insurer can raise premiums, cut benefits, shift drugs covered, even decide to go out of business as so many did six years ago when government payments dried up.

  • If the Republicans have their way, Medicare will die. The new bill offers private health insurers $12 billion in subsidies to compete against Medicare, may the best plan win! How else could they compete? HMOs spend 15 - 32 percent on overhead where Medicare spends less than 2 percent.

Nest Eggs Penalized — Been saving all your life for a rainy day? An estimated 2.4 million folks with Medicare having incomes below $14,355 ($19,245 for couples) are expected to be ineligible for low-income subsidies because of asset tests.

  • Lower prescription drug prices would allow Medicare to eliminate the "donut hole" in Medicare prescription drug prices. In one estimate, a 50 percent reduction in prescription drug prices — a discount similar to what other industrialized countries have achieved through price negotiation — would enable Medicare to close the donut hole, increase access to prescription drugs and reduce total drug spending.

Saving Money Penalized — Although you can often save 40 – 70 percent safely by buying your drugs in Canada and elsewhere, such purchases will not count toward your deductible limits under Plan D.

  • Although the new Medicare plan won't count purchases outside the US, for anyone spending less than $1,500 next year, Medicare's premiums, deductibles, and co-pays make buying Canadian drugs a far cheaper option. In fact, figuring in the drug bill's donut hole where it pays not a dime in coverage from $2,250 to $5,100, under Plan D I must purchase about $7,000 in medicine next year before I break even.

Employers Drop Drug Coverage — Despite the $86-billion the bill gives corporations to induce employers to keep providing retiree prescription drug benefits over the next decade, it isn't enough to forestall many from joining the trend toward slashing retiree benefits. After all, your former employer can legally cut your present drug coverage to the bare minimum provided by Plan D and keep his share of the 86 billion. The Congressional Budget Office figures that about 2.7 million retirees will lose employer benefits as a result of the new law.

Finally, just last week the Bush administration weighed in as Congress decides between either charging higher fees to the poorest Americans with Medicaid or reducing overpayments to insurance companies profiting from sponsorship of private Medicare plans.

Need I tell you which side the administration took?


GET UP-TO-THE-MINUTE NEWS EVERY DAY ABOUT MEDICARE'S NEW DRUG PLAN. SIMPLY SEND A BLANK E-MAIL TO GET-RXNEWS@SUDDENLYSENIOR.COM.

NEXT WEEK: Frank, in an attempt to find the perfect program, grabs Plan D by the horns and gets badly gored.

© 2005—Frank Kaiser

How to Compare Plans

Before you begin
List all of the drugs you take and what they cost. List all the pharmacies you use.

Call or click Medicare
Call Medicare at 1-800.633.4227 or click on www.medicare.gov

Questions to ask:
Does the plan cover all my medications? Does the plan cover most of my medications? If the plan does not cover a drug I take, does it cover one that will work for me? Does the plan require you to get special permission before it will cover a drug you need?

Cost
How much will I pay at the pharmacy in co-payment for each drug I need? If a drug has a high co-payment, is there a drug I that will cost me less? Ask your doctor. How much will I pay in annual premium and annual deductible? Will I have to pay the full cost of my drugs at some point after deductible?

Pharmacy network
May I fill my prescriptions at the pharmacies I use now? May I fill my prescriptions when I travel? What happens if I use pharmacies the plan does not use? May I get prescriptions by mail order?

Coordinating with your other benefits
Will the Medicare drug plan work with my current drug coverage?

Some things to consider
All plans are different. Set priorities for coverage and compare. Drug lists can change without notice. While each company's drug list may suddenly exclude a customer's critical drug, the customer usually cannot change to another plan at will. Customers have out-of-pocket costs with almost all plans. On top of the monthly premium, recipients pay the first $250 each year for drugs their drug plan covers and 25 percent of the cost of covered drugs from $251 to $2,250. Covered drug expenses that go over $2,250 are not covered until they exceed $5,100. Some plans have tiered levels — generic, common name brand drugs and new expensive drugs — of coverage. Customers pay more of the cost of some drugs than they do for others. Some plans have "step therapy" drugs. Such plans may not pay for some drugs, until a customer unsuccessfully tries cheaper drugs first. Medicare Advantage plans are managed care. Advantage plans pay for drugs, but also may limit or exclude access to a customer's physicians, health centers, pharmacies and related services. They may also have coverage limits or exclusions outside a home area, a consideration for people who live far from family members or take frequent trips. Medicare Advantage plans also offer some services that drug-only plans do not offer, including preventive health services.

Other things to consider
People who have drug insurance through a current retirement plan or employer may keep that insurance as long as their provider sends a statement that the coverage is a least as good as what Medicare offers. They need to keep the verification statement.

The pluses
People with low income, including those on Medicaid, can get extra financial help to pay drug insurance costs. People who are not low-income but take a lot of drugs may benefit if money is tight.

— SOURCES: Centers for Medicare and Medicaid Services, Medicare Rights Center

Resources
Medicare Rx — (800) 633-4227
Medicare Rights Center — (212) 869-3532


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HAVE A GREAT WEEKEND!

Frank

Frank Kaiser frank@suddenlysenior.com

http://www.suddenlysenior.com/

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