Many people in the Original Medicare Plan have some type of additional coverage to pay for care that Medicare doesn't fully cover. Buying a Medicare Supplemental (Medigap) Insurance policy is one way to cover Medicare's gaps. But since the advent of Medicare D, open hunting season for her begins with an ominous letter from her Medigap policy.
Important Notice about Your Medicare Supplement (Medigap)Outpatient Prescription Drug Coverage
My mother is being penalized for not enrolling in a Medicare D plan.
The letter explains:
"If you go 63 days or longer without prescription drug coverage that is at least as good as Medicare's prescription drug coverage, your premium will go up at least 1% per month for every month after May 15, 2006 that you did not have coverage. You will have to pay this higher premium as long as you have Medicare prescription drug coverage."
You've got to step back and ask yourself why are seniors being penalized to the tune of 1% a month? A rate of interest only slightly less than that levied by the IRS against tax cheats. I'll tell you why, their frail bodies represent huge profits for the pharmaceutical industry.
Medigap policies only help pay health care costs if you have the Original Medicare plan. If you are in a Medicare Managed Care plan or Private Fee for Service plan, you don't need to buy a Medigap policy. But Medigap plans have woefully bad drug coverage. My mother stayed in Traditional Medicare because we were both fearful of the sort of privitization schemes the Republicans had engineered. We didn't want to go near anything that had the filthy fingerprints of George Bush on it.
As it turns out, we were smart to be scared.
This brings us to open hunting season, the time of year when senior citizens across America are invited to change their Medicare selections.
Open hunting season begins on November 15th and ends on December 31st. This is a time of year as difficult and perilous for our most vulnerable citizens as the April 15th tax filing deadline is for the rest of us.
It shouldn't be this way.
The Medicare Gauntlet:
In the United States we force the oldest, frailest disabled to run a gauntlet to access healthcare. Here's just a taste of what's involved for those of you not yet acquainted with how it works.
- Competing drug plans each with varying deductibles and premiums.
- Differing and ever-changing lists of covered drugs.
- An array of co-payments for different prescriptions.
- Special and confusing requirements to be met before certain drugs will be covered.
- Pharmacy networks that may or may not include an individual’s neighborhood pharmacy.
- Limits on the quantity of pills you are eligible to receive.
- Deceptive business practices by insurance sales representatives who use misleading and aggressive tactics to persuade seniors to enroll in their private plans.
Imagine asking someone in her seventies or eighties to decipher this insane menu of drug plans. Who could possibly possess the expertise needed to navigate the web of curveballs contained in the competing plans and the deceitful sales presentations. Many senior citizens are cognitively impaired, homebound or living in nursing homes or suffering from chronic illnesses—both physical and mental.
I spent hours on the CMS web site. Look at the slogan which greets you. "Show someone you love how much you care." Look at the photo which accompanies said slogan. A senior citizen with a person meant to portray his daughter. Taken together, the message from CMS is as blunt as can be: This is a program which only a highly educated young person could possibly untangle.
But all is good in the land. Things are working just fine for those whom this travesty was designed to benefit. The pharmaceutical industry stands to gain billions in profits from the prescription drug benefit. And the nation’s giant insurance companies are putting hundreds of millions of dollars into marketing campaigns to snag bewildered consumers into Medicare Advantage Plans subsidized by taxpayers. Medicare Advantage is a Republican-created program that spends 12 percent more on average than non-privately funded Medicare plans.
Selecting a Medicare D plan has become an anxiety-filled annual rite of passage, it is a daunting and confusing challenge with landmines every step of the way. If I'm stymied, then for the life of me, I cannot fathom how a frightened and vulnerable senior citizen could begin to figure out what to do. Ask a senior citizen living on a fixed income about the shameful doughnut hole, and you will will see a beautiful smile turn into a mask of fear.
My mother and I are not the only ones hopelessly confused and exhausted.
Charles Ornstein, Los Angeles Times Staff Writer and a "veteran health care journalist" wrote this condemnation of annual Medicare gauntlet.
Puzzling out plan options for Medicare
Because I'm a veteran healthcare journalist, my mom asked me to help her pick the right plan, and I readily agreed. After all, how much work could it be? A few minutes to scan the options and pick the right one for her?
Wrong.
http://www.latimes.com/...
You need a consultant to sort through the morass. Meet JoeAnn Foeller, 66, of O'Fallon, Mo. For two years, without a hitch, she paid $35 each month for Humira, a drug that helps control her rheumatoid arthritis. Then, last January, the copay rose precipitously, to $326.
Open enrollment begins November 15, and it's worth keeping stories like Foeller's in mind as you weigh your options. "This is not an insurance product that you want to buy and hold," warns Dan Mendelson, president of Avalere Health, a strategic advisory company based in Washington, D.C., that keeps tabs on Medicare and recently released a report on the Part D market. Nearly everything about prescription drug plans—from the drugs covered to the premiums to the deductible and size of copays—can change significantly from year to year, he says. And this year is no exception.
On average, seniors in the 10 largest Medicare drug plans who stick with their current Part D coverage will see a 21 percent increase in monthly premiums for 2008, according to the Avalere data. In absolute dollars, that amounts to a fairly modest rise of about $5 per month. But the 2 million enrollees in Humana's standard plan, for example, will pay 69 percent more—$26 a month, up from $15. UnitedHealth's AARP Medicare Rx Saver is nearly doubling its monthly premium to $27.
http://health.usnews.com/...
Which brings us to the travesty of Medicare Advantage. Medicare Advantage wants my mother's business, her money and her life.
Ardis Hoven M.D., a board member of the American Medical Association, feels government funding is excessive and questions why taxpayers should have to foot the bill. "Humana's blockbuster profits from its Medicare Advantage bsuiness should make taxpayers seriously question why the govenrment is paying the insurance industry excess payments of $54 billion while planning steep cuts to physicians directly caring for seniors," Hoven said. "Congress should eliminate the government subsidy to an industry hardly in need of a hand-out and use the money to preserve seniors' access to health care by stopping Medicare cuts to physicians and limiting increases in patient premiums."
http://www.forbes.com/...
But the taxpayer-funded overpayments for Medicare Advantage will mean cuts elsewhere. Eviserating payments to insignificant people like doctors. So Medicare recipients will have fewer doctors willing to see them.
Meanwhile, many more seniors could well be affected by physician pay that faces a staggering cut, currently estimated at about 10% for 2008, and 15% through 2009. It's no surprise that an AMA online survey of nearly 9,000 physicians, released in June, reports that about 60% of doctors say the cut will force them into the position, at the least, of having to limit the number of new Medicare patients they take.
http://www.ama-assn.org/...
When are the Democrats going to repeal this depraved legislation and enact authentic prescription drug coverage for our most vulnerable citizens?
Nothing is happening. Is it any wonder that the approval rating for Congress is somewhere around 11 or 12 %?
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