Health Alert: Medicare Prescription Drug Plan D Needs Fine-TuningSomervell County Salon-Glen Rose, Rainbow, Nemo, Glass....Texas


Health Alert: Medicare Prescription Drug Plan D Needs Fine-Tuning

24 May 2007 at 2:10:59 PM

Secretary of U.S. Dept. of Health & Human Services Tells Congress to Leave Medicare Part D Alone --- "It’s working fine."

Recently Michael Leavitt’s letter was printed in the Cincinnati Enquirer saying "Don’t fix Medicare Part D; seniors find it’s working fine", which is far from the truth. What is most interesting is that Mr. Leavitt is the Secretary of the U.S. Department of Health and Human Services and the public has to wonder if he is taking any Medicare medication when he discusses this topic because he appears in denial of some of the obvious problem areas within the program.

Definitely, there are good things about the Part D program; however, there’s still a lot wrong with it.

The new Medicare Prescription (Rx) Drug Plan was approved and implemented by Congress on November 25, 2003 to provide lower cost prescription medication to Seniors and the Disabled who qualify for Medicare and/or financial assistance.

In addition, if certain people are below average income they may qualify for
additional assistance with the drug plan premiums. Some may qualify for 100-percent assistance; however, the percentage stated is a placebo statement because 100-percent assistance has a maximum government assistance payment of [currently] only $26.90, which is below what most drug plans now charge as a premium.

For example, one plan --- Medicare Blue Rx (Blue Cross/Blue Shield) last year had no additional premium costs over the government assistance of $26.90 per month; however, as of January of 2007 the plan now charges an additional monthly premium out-of-pocket expense of $2.70, which most Medicare Rx recipients --- especially those getting additional assistance --- cannot afford to pay. While it doesn’t sound like a large increase to many people don’t forget we’re speaking about clients who are on fixed income, which generally is below the

In fact, some plans will charge additional premiums as high as $20 per month more than the 100-percent government assistance amount, which will become an out-of-pocket expense for recipients in the plan. Next year Medicare projects some additional
out-of-pocket costs for premiums of up to $50 per month more, depending on the plan, than the current government assistance amount allowed. Meanwhile, the income of Medicare users doesn’t jump that high every year, sometimes income doesn’t increase at all.

Another issue is that some plans will increase premiums while reducing coverage either by limiting the amount of months per year a plan will cover certain medications or whether specific meds will continue to be covered at all, a.k.a.,
"the donut hole."

Interestingly enough, Medicare did NOT apply a yearly cost of living adjustment in the legislation for the assistance program to help those in need. Consequently, soon fewer recipients will be able to afford their Rx plans and will have to find cheaper ones or drop-out completely from the program. The only other choice then for those Seniors and Disabled on fixed income will be to apply for Medicaid assistance. However, state governments (e.g., in Texas, Ohio, etc.) are looking at approving legislation that will make it harder for those in need to receive Medicaid services. So, it’s a "Catch-22" and we may see more of this population living on our city and town streets because they will have no where to go to live or to access affordable health care.

Furthermore, when an applicant first is eligible for membership in a Medicare Rx Plan he/she contacts Medicare who will help determine which plan is best suited for the individual based mostly on what Rx medications the individual needs and which are covered by various plans. Not all plans cover all medications and not all plans are serviced by local pharmacies.

Another issue is that Medicare Rx Part D Plans cover only so much for medication within a 1-year period. Many seniors and disabled find that they may have more out-of-pocket expenses by the beginning of October of every year. It depends on what health company a plan is with and which plan within that company a client has. It has been called "the donut hole" by many who see this major dilemma. It would be safe to say that most Medicare recipients in a Part D Plan couldn’t afford additional out-of-pocket expenses.

In addition, the providers of Medicare Rx Plans have the legal right to drop coverage of any and all medications whenever they want to. So, just because a drug plan covers a certain medication at the time a person signs up does NOT mean the plan will always cover the medication. In fact, the provider may opt to cover the medication only for several months of the year and thus forces the member to pay out-of-pocket expenses to continue to purchase the Rx medication. Therefore, a recipient must scrutinize the plan every year to ensure the plan still covers all medications needed and that the costs remain affordable.

What is even more interesting and tragically ironic is that Congress recognized the need to develop a Medicare Prescription Drug Plan and did so, but now the plan is becoming unaffordable to the target population it was developed for. The lack of more effective
oversight over the program creates more problems, e.g., that the government is prohibited in negotiating cheaper drug costs for recipients.

Complicated? You bet! Imagine being elderly and/or disabled and trying to figure it all out and then deal with it properly.

Consequently, the
letter written by Secretary Leavitt is "all wet" --- especially from a man who is a "top dog" at the U. S. Department of Health and Human Services. He should know better.

Congress quickly must recognize the insensibility and weaknesses of the Medicare Prescription Drug Plan and move expediently to work with health care providers to develop a more practical and less greedy system to provide more and consistently affordable prescription medications to those in financial need. Contrary to what Mr. Leavitt says, if government doesn’t step in to regulate and/or modify parts of Medicare Rx Plan D program, many more recipients will fall into the cracks of another bureaucratic program that ignores the plan’s problem areas.

Otherwise, it’s only a matter of time before taxpayers will have to pay much more in tax dollars to provide reality-based assistance to this needy target population. Despite what anyone may believe, there is no escaping this social responsibility.



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