"Why is CBS writing me and what is Medco?"

My dear 90 year old grandmother, who spent almost all of her working years assembling light switches for Westinghouse, retired a good many years ago. At least those were different times and her union had been able to negotiate decent pension benefits, including prescription drug coverage for retirees. So, in many ways, she has been one of the fortunate senior citizens who hasn't had to sign up for Medicare part D. However, she is very confused by the ever-changing nature of her current medical coverage. I attempt to capture the substance and flavor of the conversation I had with her over Christmas. Follow this link for a cross-posted version with pictures.

Grandma Kay [GR]: "Why is CBS writing me and what is Medco?"
Hapless Apologist for the American Health Care System [HA]: "What?"
GR: "I got this in the mail." (Hands over an envelope)
HA: (reading) "Hmm. CBS seems to be switching your prescription drug coverage from Express Scripts to Medco and you'll have to transfer your prescriptions to them."
GR: "CBS? What does CBS have to do with it?"
HA: "Well, gee, I don't know. CBS must have bought out Westinghouse or something like that."
CR: "I thought somebody called "Whyacon" wrote me about my benefits last year?"
HA: "That was Viacom, now it's CBS, just don't ask me why it keeps changing."
GR: "Do I have to change?"
HA: "Well, if you want to keep getting benefits, I guess you do. Let's see, we'll have to make sure that you give Walgreen's the new information, that is if Walgreen's is a participating pharmacy with Medco like it was with Express Scripts, and have to get new info to all your doctors so that they don't send in new prescriptions or refills to Express Scripts anymore and we'll need to--"
GR: "That sounds like too much trouble. I've been getting my drugs from Scripts for years now since I retired. Can't I just keep doing what I'm doing?"
HA: "I guess you could keep getting drugs from Express Scripts but then you'd have to pay full price, since CBS wouldn't be subsidizing them--"
GR: "What does CBS have to do with it again?"
HA: "Your Westinghouse pension is with CBS now and they want you to use Medco--"
GR: "Is this something the government is doing?"
HA: "Well, no, CBS has decided they want to change to Medco. I mean, in a sense the government is involved since they haven't created a single payer system for prescription drugs--"
GR: "Why is CBS making me change?"
HA: "I don't know. I guess they think Medco will save them more money than Express Scripts?"
GR: "Will it save me any money?"
HA: "Well, no, but at least it is a pretty good benefit. Your drug costs are capped at $2000/year which is better than your sister Jean who has no cap on her Medicare drug coverage and, since it's through your pension, you pay no premium--"
GR: "But I do pay a premium. I'm paying $125 a month for the supplemental."
HA: "That premium's not for prescription coverage, that's for Medigap coverage."
GR: "What?"
HA: "Well, there's Medicare Part A for hospitalization, and then there's Medicare Part B for doctors visits, but not all of that is covered by Medicare, so that's why you're paying the Medigap premium and then they did add Medicare Part D for prescription coverage, but your pension coverage is better than the Part D so we decided you didn't need to sign up for that. Remember?"
GR: "Why is it so confusing? And why does Dom [her sister Jean's husband and a WWII veteran] get to go to the VA and get all his doctors and drugs from one place?"
HA: "Because Jean and Dom keep voting for Republicans because the health care industry paid for those Harry and Louise ads that scared everyone into thinking that the government was going to create a complex and inefficient health insurance system!"

I think that the moment I lost it was when I said that the premium she was paying was for Medigap coverage not for prescription drug coverage, as though these were rational categories that any 90 year old retired factory worker who never even got to go to high school ought to be able to keep straight. It's not like my grandmother is stupid or has dementia. She's quite capable and living on her own, handling her bills and everything, but the complexity of her health insurance situation is so many orders of magnitude beyond anything else with which she has to deal. Meanwhile, her brother-in-law Dom is getting quality, cheaper health care from the VA. Why can't it be as simple for all senior citizens and for the rest of us, for that matter?

The 2007 House Democratic leadership is focusing on one small change that would make it simpler and cheaper for senior citizens who do not have private drug benefits by allowing seniors to choose a prescription drug plan administered directly by Medicare, but even if this passes I still won't be able to answer my grandmother's question about why health insurance in the United States is so confusing when virtually every other major industrial country offers universal health coverage.

•  I feel for ya

  My mom had similiar problems but thankfully I had an insurance guy who I've been with for 19 years and is a personal friend. He did her right.

  I can't imagine how others are dealing with all this bs.

  by paddykraska on Sat Jan 13, 2007 at 05:58:03 PM PDT

•  I empathize -

  my mom needed help and this was before we were in the center of the labyrinth as we are now.

  Of course, confusion is good -- for profits -- because maybe people won't get all benefits if they're confused.

   

  by xanthe on Sat Jan 13, 2007 at 06:05:44 PM PDT

•  Same story playing out all over the country...

  My parents have been through it too, but they were lucky at least to have kids to help them navigate the system, as is the case with your grandmother.  That's bad enough, but can you imagine the poor people trying to muddle through the muck of Medicare D without a support system?  What about those who are too ill or do have dementia?  What we're doing to our seniors is heartless and cruel.  

  by poe on Sat Jan 13, 2007 at 06:08:03 PM PDT

•  Sorry to be blunt, but the people

  who design and run these programs are boogers.

  Best wishes to HA and GR.

  by magnetics on Sat Jan 13, 2007 at 06:22:56 PM PDT

  •  it's supposed to be hard

    like getting rebates, it's supposed to discourage people from using it.  It shows that government doesn't work, so why does anyone have to pay taxes it's cynical.  

    by anna shane on Sat Jan 13, 2007 at 07:04:00 PM PDT

•  My 88 year old mother needed advice also. I

  tried and at least she didn't do without medication or medical services (though a few times I gave up the struggle and paid a bill myself).  I have two law degrees and 25 years working in the arcane rules of the federal contracting system, but I never really felt that I grasped the insurance, medigap, medicare, etc. structure!  I tried, but as I would read the MEGO (my eyes glaze over) complex almost always did me in.

  Single payer: YES!

  by gfv6800 on Sat Jan 13, 2007 at 06:39:13 PM PDT

  •  "MEGO" here, too

    I have a law degree, my mom's an accountant and my brother's a research librarian and we still have to spend a significant amount of time and effort wading through this insurance morass, fighting the "glazed eye syndrome" all the way!  Single payer, single provider, yes please!  

    by Abby Kelleyite on Sun Jan 14, 2007 at 09:48:53 AM PDT

•  Your answers to your grandmother's

  questions were correct, but the VA is not always quality for less.  It depends.  I qualify to use the VA, but they always want to send me three hours away.  They want to make the appointment for me and act annoyed if I do not like the day or time.  They do not want to work around my employment, such as it is.  Going to the doctor may be "free" or imexpensive, but I have to pay transportation and lose a day's pay, to get told that nothing is wrong.  Now I understand that knowing nothing is wrong is valuable information, but still, why can't my local VA make that determiniation.  It seems they should refer me out if there is something of concern.

  The last time they wanted to refer me, they said I had an impending emergemcy and I needed to go within the week.  I said I would ask my employer which day I could take off and call the VA right back.  I called every day for a week.  They never returned my calls.  That was three months ago. They still have not called me back. So much for my emergency.

  by azindy on Sat Jan 13, 2007 at 06:55:18 PM PDT

  •  sorry to hear about your troubles w VA

    You are right to point out that the VA is not a perfect model.  For my uncle Dom who is located near Bridgeport, Connecticut, the doctors are all pretty convenient but it makes sense that that wouldn't be the case everywhere throughout the country.  I would hope that at least this distance/referral problem would be lessened with a unified universal coverage system.  As for the problems w Va not getting back to you in an emergency, I can merely extend sympathy.  Quality control is a potential problem with a government run system, though most of what I've read indicates that the VA is at least as good as HMO's.  Good luck with getting the care you need.

    by Abby Kelleyite on Sun Jan 14, 2007 at 09:01:05 AM PDT

•  added the tag "health care" n/t

  by elfling on Sat Jan 13, 2007 at 08:01:06 PM PDT

•  I have Medco and its a mail order prescription

  plan that can be a pain in the butt.  My plan will allow you up to 3 prescriptions at your local pharmacy after that you have to get another prescription from your doctor and mail it to Medco to have it filled. If you don't you will be responsible for the full cost of the prescription.
  They have a set price for all your prescriptions. You have to request by mail for a refill or
  call them by phone or order online.  I believe that they offer automatic refills and will contact your doctor once the prescription expires.
  From my experiences I pay more towards my copay each time I utilize the local pharmacy versus sending it to Medco.

  by mistletoe on Sat Jan 13, 2007 at 08:54:23 PM PDT

  •  pretty much the same

    deal as my gram seems to have and not too different from the one with Express Scripts. She can use her local pharmacy for a new prescription for a short time but then needs to go mail order and gets 2 or 3 90 day refills on her maintenance meds. From what she has told me about Express Scripts, they didn't contact her doctor when her prescriptions ran out; she had to do that part and get the doctor to send in a new prescription.  At least I've been able to find fax forms that I could download from each company's website that she could give to her doctors so that she didn't have to mail the new prescriptions in herself.  Another problem with all these PBMs (Pharmacy Benefit Managers) is that they keep trying to make her switch meds.  The last one tried to make her switch from one statin (cholesterol med) to a different and cheaper one even though the statin they were recommending was noted for having troubling interactions with some of the other meds she was taking.  As someone else recently and elegantly pointed out, the health "industry" is about profit, not about health "care".

    by Abby Kelleyite on Sun Jan 14, 2007 at 09:42:55 AM PDT