Medicare Part D: or, why I don't want to go to work tomorrow
Mon Jan 02, 2006 at 09:33:19 AM PDT
Tomorrow I need to go into the office. Tomorrow Medicare Part D, the Revenge of the Sith or that Stunningly Unimpressive Shark in the Fourth Jaws Movie, will take effect. And I'm a little bit scared. I hope I don't need to be. Maybe a better word is apprehensive. So, can we look at this, and see why I'm apprehensive? And maybe the community here can assuage my fears.
UPDATE: sequel diary posted
here. Let's begin. I work with sometimes mentally ill, sometimes not, people who have HIV or AIDS. They are almost all on Medicaid or Medicare. In fact the
Human Resources and Services Administration notes 60-80,000 people with HIV/AIDS are such "dual eligibles." The new drug benefit changes, therefore, affect those I work with directly.
While I appreciate the "attempt" to simplify the program by our erstwhile government, the fact is that at first sight, it seems Medicare Part D is designed solely for the purpose of driving people into poverty. Consider these quotes:
Medicare eligible beneficiaries not eligible for low-income subsidies can apply for and enroll in the standard benefit. The standard benefit requires that the beneficiary pay a $250 deductible. When the deductible is met the beneficiary then pays 25% of the cost of all prescriptions up to the initial coverage limit of $2,250.
Now one more fact:
Dual-eligibles will lose their Medicaid prescription drug coverage as of January 1, 2006. They will continue to receive other health care services through Medicaid and Medicare. The vast majority of their prescription drug benefits will be provided through Medicare.
Let's call 'em Aid and Air; less confusion. In other words, people who had both Aid and Air - which many HIV+ consumers do, since Air has hospital coverage - will lose prescription benefits form Aid and are left with the coverage offered by Air. (This is getting kind of ironic.) Under Aid - they paid little to nothing for medication costs; under Air - they will pay quite a bit.
stage 1
During Stage 1 they will have some help. They will only pay 25% of their medication cost until the total cost equals 2,250. So, for example, if your medication costs $100, you will pay $25, and Medicare $75, and so on, until you've hit $2,250. At that point the total cost of contribution from the consumer - your grandma, for example - would be $562.50. The real cost may be higher; formerly, vitamins and supplements would be coverable under Aid if prescribed by a doctor; now, that must be paid from the patient's own pocket. It is still not clear what other medications will not be covered, but a partial list is available from The Body:
These excluded drugs include: drugs for weight gain; barbiturates (used to treat seizures in older people); benzodiazepines (used to treat acute anxiety, panic attacks, seizure disorders, and muscle spasms); and over the counter medications.
stage 2
Stage two, the famous doughnut hole in coverage (and what a misleading moniker!), will leave people without help until their total drug costs:
At this point the beneficiary enters what is known as the "donut hole" and must pay the full cost of each medicine until they spend a total of $3,600 in out-of-pocket expenses (including the deductible and the initial coinsurance). After the beneficiary hits the "catastrophic limit" of $5,100 in total drug expenses the beneficiary will pay $2 for a generic drug and $5 for all other drugs or 5% coinsurance, whichever is greater.
Let's consider this math. First of all, it doesn't make sense. 2,250+3,600=5,850, not 5,100. So, is there another "doughnut hole" between the out-of-pocket expense limit and the point at which the catastrophic limit kicks in? Or, perhaps, that 5,100 is how much the beneficiary themselves must spend before their contribution is considered catastophic?
And hell - I don't really understand why there's a doughnut hole at all. Who's it going to harm? People who worked prior to getting Social Security. Because their incomes will be just too high for that low-income aid; the cap for that seems to be 12,750 (someone correct me if I'm wrong.) So anyone getting more than a thousand a month, in New York City, will have to pay the total cost of their medications for a period of time.
Why does this worry me so much? Because most of these people are on Social Security, have little savings after the economic destruction of the last few years, and if their medications are more than a hundred or so a month, they're going to have to economize into starvation.
For a point of reference - some beneficiaries need thousands of dollars of medication per month.
stage 3
will anyone even get this far? But after catastrophic coverage is reached, at whatever number, the beneficiary will pay either a small percentage or a fixed dollar amount.
thoughts
Mostly worried. I have some consumers who have gotten themselves back into the work force (the goal of my program is empowerment), but still however depend heavily on Medicaid and Medicare to pay for their expensive medications (In one case, 2,500 a month.) There will be a gap in their goverage. They are freaking. And because of the nature of their disability, some of them are just now coming to me with letters and asking me to help. OK, better than never. But how do I explain the change from a seemingly simple system to this monstrous program where they do not know how much they are going to need to contribute, where Medicare itself cannot be counted on for answers? The HRSA notes:
The thing that's difficult to understand about Part D, I think, is that this benefit is really four benefits wrapped up in one. The benefit that the Medicare beneficiary will experience will differ depending on their Medicaid status, what their income is, and what their assets are. So the Medicare benefit for one client that you're serving will be very different than the Medicare benefit for a second Medicare beneficiary that you're taking care of.
There's a lot more I could say but I'd like to leave it at this for now and find out what other people are thinking. How will this change affect you and your family? Have they signed up and also signed up for a plan? (Yep, two types of signing up; three, actually, when you pick your economic level from the private company offering the plan.)
one last thing please take the time to comment including any links that might help people get through this, ideas, suggestions, news stories - anything. Be very happy to see it all and if all hell doesn't totally break loose I shall be happy to write a follow up diary or something
