Episode 1: The Phantom Benefit
One of President Bush’s largest and most important domestic policy initiatives launches this week, namely Medicare’s new program for prescription drugs. The cost is enormous--an estimated $720 billion over the next 10 years. Will it work? (Well, my knee-jerk reaction is to say no because it was conceived by the Bush Administration. But, being a smart person who tries to show respect and practice tolerance for those that disagree with me – even if they are off kilter by a million feet. I will not jump to any conclusions).
So to that end, I present to you a Medicare primer. Take a read and then you too will realize that President Bush is bent on destroying Medicare…(along with social security, but we’ll get to that one at a later date)
The true test of Medicare's new program to pay for prescription drugs rolls out this week, as drug plans start marketing to consumers and senior citizens start evaluating their product offerings. Because of this, now, for the first time ever, seniors will get specific answers to basic questions they have. Questions such as,
“Will my medications be covered?"
"Can I buy them at my local pharmacy?" and
"What will it cost?"
How good a success this new government program will be is going to rely on how the average (and not so average) consumer reacts and responds to it. If seniors decide that the drug plans will save them money and provide valuable insurance protection, experts (I want names people! Exact names and contact information for these so-called experts) predict that enrollment could soar as high as 30 million people.
But, if people decide the plans are too expensive or limited in their coverage, results could be disappointing. (I, personally, having a good knowledge about the insurance industry, think this is more likely to happen. Most people will decide that the coverage would cost them WAY too much money. Also, the information these people are going to get are excruciatingly hard to read.) In Illinois, as many as 16 private companies are expected to release a flood of sales pitches aimed at 1.6 million Medicare members in the weeks and months ahead. This will be through the mail, over the phone and through television, radio and print ads. Oddly enough, the internet is not going to be used as a major marketing avenue so individuals who surf the internet and are on Medicare will just have to go back to reading the ads for free sex and cheap Viagra.
In the decision-making process, getting unbiased information (and by that I mean information that is NOT coming from one of the private companies offering the plan) will be important, since drug plans will have an interest in promoting their products, not providing objective analysis. If you want information about where to find unadulterated assistance is available through local departments on aging, state senior health insurance counseling programs, Medicare and other sources.
Some 42 million people get health care through Medicare, including 36 million seniors and 6 million people with disabilities, but most medications aren't covered. Instead, many people in Medicare have typically had to pay for drugs on their own, while a minority have had drug coverage through retiree health plans, supplemental insurance or other government sources.
Besides being a difficult subject to understand, the changes are also an extraordinary shift in how Medicare operates. For the first time EVER, a new benefit will be paid for by the federal government, yet administered entirely by private companies.
Because it is a difficult concept to figure out, there are multitudes of community groups and state and federal agencies that have trained thousands of volunteers to help people understand the new benefit.
Enrollment in the new plans starts Nov. 15 and lasts through May 15. Coverage begins in January 2006, or the month following enrollment, whichever is later. Most consumers who sign up after this initial enrollment period will pay a penalty of 1 percent of the plan's premium for every month they waited.
There are notable exceptions though. For instance, in my home state of Illinois, more than 218,000 residents qualify for both Medicaid and Medicare because they are old, disabled, sick and impoverished. This group will have to enroll in a new Medicare drug plan by the end 2005 because their Medicaid drug coverage ends on Jan. 1, 2006. (Isn’t that special? – way to be humanitarians there guys)
To further complicate matters (as if this new system needs more complications) there will be standard drug plans and non-standard drug plans. The Medicare drug benefit's standard structure calls for consumers to pay a $250 deductible before the government starts paying for drugs. From $250 to $2,250, consumers will pay 25 percent of drug expenses, up to $500. Between $2,250 and $5,100 there is a gap known as the "donut hole" and consumers are responsible for all of those bills, up to $2,850. After $5,100, a consumer will pay 5 percent of drug charges. (Everyone got that? Everybody understand? Good. Wait a minute, you in the corner, yeah you, in the t-shirt and jeans…no, not you, the one in the back, way back there in Nebraska…do you got that? You do? Ok, you just looked really confused. Are you a conservative? No? You’re a member of the green party you say, oh, well that explains it…)
Another thing worth noting is that the Medicare drug plans can change the medications they'll pay for with 60 days notice. (So, one month your Prozac is covered, but, bam! 2 months later it isn’t and you have to resort to making your own version of Prozac – from what I have gathered that includes a LOT of alcohol)
Additionally, adults and advocates are also asking (how’s that for alliteration?) what the effect will be on Medicaid. These consumers – many of them mentally ill, cognitively impaired, severely disabled or in nursing homes – may have trouble understanding how the new Medicare drug plans work, especially restrictions on medications and participating pharmacies. Help from family members will be critical for this group to ensure that the individuals have an idea of what is going on and also what will be happening to their benefits.
Tomorrow: The new benefit in simplistic, even-Bush-could-understand-them, terms, or
Episode 2: Attack of the (Drug) Clones
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