All this talk about Health Insurance. Should we have a public option. The shrill warnings of "YOu
don't want the govt between you and your doctor do You?"
I say Shut the Fuck UP about that lame overused excuse. They are already many pencil pushers,
now keyboard pickers stopping many insured from receiving the tests, or health care they
need, EVERYDAY.
I have been through the gambit, from private pay of a huge hospital bill, to Blue Cross,
to Medicare, to finally trying to qualify and sign up for Medicaid.
First point: You must be virtually living in poverty, with no home , to qualify for
Medicaid. You can not have over a penny in the amount of $2000. And, yes your
home counts as an asset. Unless you have a spouse, or handicapped child, or a
caretaker who have lived with you at least 5 years.
In order to qualify you must fill out reams of paperwork, and it takes weeks, months, 3 being
the average to mull through the Medicaid nightmare. So if you know someone on Medicaid,
they NEED IT. I know a family who recently qualified for Medicaid. They aren't lazy, just poor
and not educated. I am totally convinced of one thing: Knowledge is Power.
So Medicare, the kind that kicks in when you are 65, you have no choice. Unless you were
getting city, fed, or even GM health provided insurance. No wonder GM are going bankrupt. The
health insurance for their retirees must be astronomical.
But Medicare doesn't pay for the medications. They figure you can handle this yourself.
Then GWB came up with the part D, the drug portion. Handed it over to the private
insurance companies with sweet breaks for them. Here is how it works.
There is an enrollment period of Oct-Nov of each year. Meaning if you sign up with an
insurance company, you are stuck with them until the next enrollment period. And if
you want to drop them before the next enrollment, well you must get permission
from Medicare to do so.
They only have 2 reasons available to drop this type of insurance.
- You tried to sign up for another Rx plan while under the current one.
- Someone else not qualified to sign for you tried to drop the Rx insurance.
WTF. What about if you get a letter and they change the contract rules, by not covering certain
drugs anymore. Couldn't change of contract be a choice? Nope.
I don't understand why: Fuck you, eat this insurance , isn't a choice.
So of course you aren't allowed to drop whatever RX program you pick, you are stuck
until the next enrollment of Oct-Nov.
Here's their payment scheme, all the companies pretty much have the same exact service
deals, payment schedules. The only thing that varies, is how much the premiums are, or
how much they rip you off.
Let's examine this pay the first $2700 portion of the Part D RX plan. Depending on
what program you were tricked into, you may have an out of pocket cost, before
the drug card pays one dime. I noticed this could vary, from $250-$500. Usually
for a premium running around the $25 range every month. The thing you don't realize
is the $2700 includes the co-pays you must chip in for every script. These can vary
from 0 to up to $60 per 30 day supply. Many drugs aren't even covered at all.
So the first $2700 isn't just paid out by the insurance company, you chip into
that total as well. In my case it came to $840, the insurance card payed out
$1822, and now will not pay one dime until I have spent over $4000 of my
own money.
Now the premium is $53 a month, so that costs me another $600 for the year.
Bingo! That is why you keep hearing how the Rx part D plan saves you on average
$1200. That is about what they were out, before I reached the "Donut Hole"
The part where I now pay for all the drugs until I have a total out of
pocket of around $4200, then they will start paying $6 per script or all but
5%, which ever is greater for me. So if the drug cost $300 ( I am currently paying
all of it for now) then they would charge me $15, only once I have filled the
Donut Hole with my own moola. While still being obligated to pay the Rx $53
premium every month. And the drug price with the drug card, RETAIL.
So I figured out the drugs for a year, and no surprise, I fill the Donut Hole, just as the
year ends, then it will start over again at the $2700 deal. Now President Obama
promises to make the Donut Hole drugs half the price, that's great, but why is
there a fucking Donut Hole to begin with? Wouldn't it of been better to drop the
whole $2700 limit and just pay for the fucking drugs with co-pays, like regular
drug insurance. Now it will just save the insurance companies a bunch more
money, because folks who were punching the Donut Hole won't reach it
anymore if the drugs are half. But those with limited income will still be spending
more and more of their money, drugs goe up, the $2700 stays the same, doesn't
ajust for inflation. Pretty shit deal for seniors.
I did get one thing right, after seeing my mother get the shaft on United Health Care, I
will just stick with the Medicare. They have no incentive to kick you off rehab because
they are worried about profits. These Medicare private deals are real shit in my
opinion, but I will have to save that for another diary.
When they designed this Part D, it forbid Medicare from negotiating drug prices.
Once again, all to the advantage of big Pharma, and the Insurance Companies. Because
who is taking the hit on all these over priced drugs, citizens of the USA. The US
Government should not only be allowed to control the drug prices, they must if
we are going to have any real reform, in all areas, not just Medicare Part D.