Medicare Part D, Boondoggle or Benefit?
The federal Medicare program has always included a prescription drug component. That program is limited in terms of who can access the benefits, and very limited in terms of which drugs are covered and for how much.
Seniors have been clamoring for an expanded benefit for a long time. AARP, one of Capitol Hill's most effective lobbying groups, has been spending millions on advertising to influence Congress to create an expanded drug benefit.
The benefit being sought would be an historic expansion of this major social program, costing billions and affecting millions. Adding a discount drug program, underwritten by federal dollars, would allow senior citizens to take advantage of lowered premiums and co-pays.
All of this government program happy talk sounds like a page from the liberal playbook. Making people, especially a traditional liberal special interest group like the elderly, more dependent on an expanded federal program is how the Democratic Party has corralled the "gray" vote for years.
Flying in the face of tradition and convention, this new Part D prescription plan comes from the Bush Administration; the same administration vilified by the AARP as being "against the interests of senior Americans," during the 2004 presidential campaign.
Conservative Republicans were shocked and disappointed when they learned the full scope (and cost) of the president's program. Claims of "nationalizing" the drug industry, an effective bugaboo when used against Hillary Clinton's healthcare plan, were dusted off and trotted out in front of the talk circuit.
Democrats were stymied. Their tendency towards expanding federal programs clashed with their partisan sensibility, fearing that anything (no matter how good it sounded) coming from the Bush Oval Office had to be bad.
Remember my old adage: if both political parties hate something, it just might be perfect!
While a number of Democrats supported the program, an even larger number took off around the country to attack it and the president. Maryland Reps. Steny Hoyer (D., 5th) and Ben Cardin (D., 3rd) held a series of "town meetings" to accuse the White House of abandoning seniors.
The GOP countered that many would save money on their care while being able to choose benefits most closely aligned with their individual needs.
So here comes Medicare Part D. The enrollment has begun with benefits beginning in January, and seniors have until May to enroll or face a punitive premium in the future should they decide to sign up after the deadline.
The basics of the program are: a monthly premium per person; a small co-pay for drugs purchased; a total annual allowable expense up to around $2,500, at which point the individual would have to cover the cost of their drugs until they reach an annual catastrophic limit of $3,600, when Medicare takes over 100% of the cost of drugs.
Cruelly called the "donut hole," this black hole of lacking coverage sends shivers through folks who can easily add up their drug cost and see the impending brick wall.
Low income and poor seniors don't have the same worries, though. They still can get their drugs with no premium and no co-pays, and the donut hole isn't a worry for them.
The program forces seniors who have current drug coverage to analyze their personal situation. They need to decide if their existing coverage is adequate, will remain in affect for the foreseeable future, and how that benefit compares to the Part D program.
Many are not so lucky. A number of seniors, who had coverage that included a drug benefit, have received a letter from their health insurance company stating that - effective December 31 - their drug benefit would terminate. The letter went on to state that they could take advantage of the new Part D benefit.
Imagine the nightmare that accompanies that letter. Your health insurer, probably someone you've had a long and satisfactory relationship with, suddenly alerts you that your benefits are changing, and that you need to enter the market to find a drug benefit.
For younger Americans, being jerked around by an insurance company is no big deal. If you've changed jobs more than once, you've dealt with this nightmare. Much of the work of finding decent coverage can be done with a computer and Internet connection, and maybe a phone call to a computerized answering system or two.
Fine for a Gen X'er or someone suffering from carpal tunnel syndrome, but for a "seasoned citizen," dealing with these insurance behemoths can be a terrifying experience.
By way of example, take a lady in Brunswick. She and her husband received that letter from United Healthcare, announcing the termination of their drug benefit. Almost immediately, they were inundated with offers from the thirty-four (34) prescription drug companies approved to offer Part D plans in Maryland.
Words like formulary (the list of covered drugs), generic vs. name brands, symptoms, side affects, and authorized substitutions make heads swim in medical school, even more so around the family dining table.
In the case of the Brunswick family, they'll save a little money. After some careful research they found a plan that included all of the drugs that they take on a regular basis. One can wonder whether everyone will have that same kind of luck. Probably not.
If you're affected by this, or your parents or grandparents will be, have them contact their local senior center. If you live out in the county, contact the Frederick County Department of Aging. County residents are fortunate to be served by a dedicated and highly competent team under Director Carolyn True. Sharon Lynn, County Medicare Specialist, is an amazing resource of helpful information. You can reach her at (301) 694-1605.
With proper research, careful analysis, and the help of trained professionals, this boondoggle can be turned into a benefit.