Medicare Overhaul + Bush Administration = Screwed over Elderly: The Sequel

Episode 2: Attack of the (Drug) Clones

Today, we will examine the new Medicare benefit in simplistic, even-Bush-could-understand-them, terms.

Why? As I mentioned in yesterday’s entry, the Medicare prescription drug disaster is upon us as enrollment begins November 15th.

What it does: Provides coverage for prescription drugs.

Participation: Solely voluntary. (But you know the Bush administration. If you don’t join the party, they’ll come and get you.)

Who is eligible: All of Medicare's 42 million members (and counting…)

When it starts: For people who sign up by December, the benefit starts Jan. 1. For those who join later, benefits begin the first day of the month after sign-up.

Initial enrollment: Consumers can sign up between Nov. 15, and May 15.Penalty: Most people who don't sign up during this initial enrollment period will pay a penalty of 1 percent of the plan's premium for each month that enrollment is delayed. (Nice)

Running the program: unlike traditional Medicare, private companies such as Cigna Corp, UnitedHealth Group, Humana Inc. and Blue Cross and Blue Shield of Illinois will administer plans. (Eep. I have worked for two of those, and know people who work(ed) for the other two – and I can only say, I hope the companies do a better job with this than they do with their customer service, otherwise…watch out!)

Drugs covered: Each plan will have a list of drugs for which it will pay. All plans are required to cover at least two drugs in 209 categories. (You read that right, 209 categories. My first question, is there really that many categories of prescription drugs? And if there are, why? My second question, why only two drugs from over 209 categories. I mean, if there are 209 categories, wouldn’t you think that there are a LOT of drugs? Think about this. If there are, for arguments sake, 10 drugs per category, that’s 2,090 drugs. Only 2% of them would be covered. The remaining percent would have to be covered by the individual, watch out)

Now we get to the fun part. The pricing. Hold on to you chair, this could get a little rocky…

Standard drug plan costs for consumers:

Avg. monthly premium: $32

Deductible: $250 (before any benefits are received)

Expenses: $250--$2,250

Consumers pay: 25% cost of drugs up to $500

Expenses: $2,250--$5,100

Consumers pay: 100% cost of drugs up to $2,850

Expenses: Above $5,100

Consumers pay: 5% of the cost

Simple, right? (How about people that can’t afford that, are they just automatically forgotten about? Well, it IS the Bush Administration, but they say that they did come up with a financial assistance program, and, since it was conceived by people with a lot of money, I’m sure it is kind to those that don’t have a lot of money. After all, the Republicans are a party of inclusion.)

Financial assistance: People with low incomes will qualify for a program known as Extra Help. To qualify, a single person must have an annual income of less than $14,355 and a married couple's income must be less than $19,245. Those who qualify are not responsible for paying premiums, deductibles or co-payments.

Retiree coverage: Employers will be sending out letters this fall telling seniors if their retiree plans' drug benefits are at least as good as Medicare's. To understand the full consequences of making a switch to a Medicare drug plan, people should consult the retiree health plan administrator.

Supplemental Medicare coverage: Seniors with Medigap policies that cover drugs can retain these policies, but no new policies will be sold. Seniors who want to switch to a Medicare drug plan will want to analyze the impact on their supplemental Medicare coverage before doing so. (And I mean A-N-A-L-Y-Z-E, check everything and then recheck it.)

Medicaid and Medicare members: Some very poor people belong to both Medicaid and Medicare and will be automatically assigned to a Medicare drug plan this fall unless they choose a plan on their own. The Medicare plans may put more restrictions on covered medications and pharmacies where drugs can be purchased. Medicaid drug coverage will lapse for this group, including 218,000 Illinois residents, at year's end. Medicaid will still cover these individuals for other health-care services though.

Now, while I was writing this blog and doing my research, I discovered some things that were troubling. For example:

1. The complexity of the drug benefit is forcing many seniors to retain outside experts to assist them in making overwhelming choices. Some, who have the financial means to do so, are hiring lawyers. That’s not good.
2. It seems without doubt, the "benefit" was designed to confuse, intimidate and bewilder even the smartest person.
3. Will the government herd seniors who contact Medicare for advice into prescription drug programs, which will restrict them to a handful of drugs that may or may not be appropriate? (I’m sure they won’t, I’m sure the government assistance will be truthful and straightforward – you have to imagine that statement was said just oozing sarcasm)
   
   One of the great lessons of Hurricane Katrina was that we have a government that does not believe in assisting the most vulnerable of its citizens; add to that the fact that we now have the presence of these same people presiding over what this administration is calling the greatest expansion of a federally run entitlement in half a century.
   
   Tomorrow: How the government and private companies are getting the word out, or
   Episode 3 – Revenge of the Bush(League)