Local Columns
Senior Lines: The Medicare Rx Plan - can it be fixed?
By Rose Safran
Seniors have again been solicited by insurance carriers participating in the Medicare Rx Plan. So many companies have jumped into the scene, inviting signing up. Should seniors again research - or have researched - where the best values lie? Should seniors go for some of the "enhanced" options now being offered? Get "donut-hole" coverage? Or try to assess what's now available?Compare new ideas?
Surely, there are more pleasant ways to use that precious dwindling commodity called "time?"
The Case Simplified
Over the years, most seniors have bought various kinds of insurance - for cars, homes, possessions, travel, life, fire, liability, theft, accident, long term care, major medical, umbrella or catastrophe. In general, we seniors "buy" insurance coverage for protection against some level of loss. Many of us tend to "buy" a certain and specific amount of insurance, depending upon our perceived need and desire for adequate protection, paying monthly, quarterly, semi-annual or annual premiums for this insurance.
Sometimes, our employers assist with premium payments. If we want to reduce the size of the premium paid, we can often increase a deductible. Most of the time we can gauge what we are spending for a set amount of insurance. Policies, in general, are reasonably clear, spelling out just exactly what is covered, what is not covered, the dollar amount of insurance available or allowable and the cost for that level and kind of insurance. Yes, policies can be tricky at times, requiring a trained eye to interpret the fine print.
Along comes Medicare Rx in 2006 - perhaps the most convoluted, complex, strange insurance program ever devised in my lifetime - and created for Medicare-eligible American citizens; i.e., seniors, too many of whom are ill-equipped to understand it.
In 2007, the Medicare Rx coverage "threshold" before falling into the maligned wicked "donut hole" requiring 100 percent payment; i.e., no relief from any prescription drug costs, increases slightly - to $2,400. Reaching that $2,400 includes the combined outlay of the total co-payment, the total amount the plan or any other source pays. Two regular $100-a-month prescription drugs will easily consume the entire $2,400 figure - and any additional and unpredictable drug expenses in 2007 will place the covered person smack into the "donut hole," requiring paying 100 percent for all prescription drug costs, until the total outlay reaches $3,850. That $3,850 must be 100 percent true out-of-pocket expenses paid by the covered person. In other words, to get to the "donut hole," both plan payments and co-payments are combined, that is, added together; however, once in the "donut hole," the covered person's total out-of-pocket payments made from Jan. 1 on are the only ones applied. After the true out-of-pocket costs exceed $3,850 for 2007, "the majority of drug expenses until the end of the year" are paid. (Note the word, "majority." There is still a co-pay.) Of course, no premiums for the insurance are included in this fancy arithmetic.
Also complicating the arithmetic is that not all prescription drugs are considered equal. A bizarre "formulary" concept includes three tiers of variously priced prescription drugs plus a specialty tier and in some cases, qualifiers such as prior authorization for the drug, quantity limits, etc. Doctors and patients are invited to study the lists and are encouraged to select the less expensive, or generic, drug if one is available. But, in a crisis, how many will do so? Or have the time to do so? To say nothing of the truly sick, incapacitated, or those who cannot cope and have no advocate to help. It also says nothing about all the wasteful paper mailed, the arithmetic, the lists of tier-associated drugs. Ask a pharmacist how much a drug will cost and the answer is, "I won't know until I go into the computer." The human brain cannot contain; i.e., remember, all the information involved.
The Medicare Rx Plan appears to have been prepared by a United States legislative body that worked with business organizations with an astute eye on the bottom line. Voting against it in our area was Rep. Tom Allen, but voting for it were Senators Susan Collins and Olympia Snow. The thinking in accepting and passing this legislation, I was advised, was that anything or something was better than nothing - that is, any relief from escalating prescription drugs and potential catastrophic costs would help. At the low end of the medical needs scale, yes; for real catastrophic cases, presumably yes, although qualifiers make this somewhat questionable. Significantly, there is no way to figure out costs for coverage, let alone anticipate one's needs in relation to ever-changing drugs, new drugs, changed health conditions. Additionally, I've noted that there is no price
control: medication I used prior to the introduction of Medicare Rx for which I received a 10 percent senior discount now cost more accelerating reaching that $2,400 limit.
The Medicare Rx legislation is a done deed. Unfortunately, our short-sighted congress preferred not to understand that to "fix" this program will require fancy maneuvering. It's comparable to "fixing" the income tax. Every bit of "fixing" tends to add more mix-up. (Isn't it better to "do it right" in the first place?)
Nevertheless, I feel that there are measures seniors and other concerned Americans can take at this point. There is a new group in congress - the legislative mix has changed and should be more citizen-oriented than the previous group. Letters, phone calls, e-mails to congressional representatives may not be in vain. Americans deserve a clearer, easier to follow, less complicated, less restrictive and less qualified prescription drug program.
To achieve it, a collective voice needs to be heard.
