Posted on 02/21/2006 7:02:35 AM PST by AZRepublican
A $400 million campaign by the Bush administration to enroll low-income seniors in prescription drug coverage that would cost them just a few dollars per prescription has signed up 1.4 million people, a fraction of the 8 million eligible for the new coverage.
At this rate, by some calculations, the government is on track to spend about $250 for each person it enrolls, and even then it would have only 2 million poor senior citizens taking advantage of what is perhaps the most generous government benefit available today.
"It's a very, very good benefit," said Deane Beebe, whose organization, the Medicare Rights Center, has been critical of many aspects of the new Medicare drug program, called Part D. "It's probably the best thing about Medicare Part D, except that most people don't know about it or don't know how to apply for it or are not comfortable or capable of applying."
When Congress enacted the first-ever drug plan for Medicare's 42 million beneficiaries, it created a tiered system in which the poorest and sickest seniors pay the least. About 6 million elderly and disabled people were switched from state Medicaid programs to virtually free Medicare coverage. Retirees at the high end of the income scale have the option of purchasing a plan with standard out-of-pocket costs such as monthly premiums, deductibles and co-payments.
The group sandwiched in between -- those earning too much for Medicaid but less than $19,000 -- qualify for coverage with no premiums, no deductibles and co-payments of less than $5. Congress gave the Social Security Administration $500 million primarily to identify and enroll them.
(Excerpt) Read more at washingtonpost.com ...
You can lead a horse to water....
"It's probably the best thing about Medicare Part D, except that most people don't know about it or don't know how to apply for it or are not comfortable or capable of applying."
I think I figured out the problem...
"....The group sandwiched in between -- those earning too much for Medicaid but less than $19,000 -- qualify for coverage with no premiums, no deductibles and co-payments of less than $5."
I can assure you that this is a false statement if it is (as it appears) supposed to be a representation of Medicare Part D Rx plan.......there is a monthly premium, a 250 deductible, and a 2250 dollar limit on the actual discount which is tabulated at absolute top-dollar retail for the purpose of reaching the 2250.
It appears that most people just want to show up at the doctor's office, hospital, or pharmacy whenever they feel like it, get some service or prescription at little or no cost to them, and be on their merry way. Say what you will about whether or not the program is the right one in the first place, but there are just too many ways to find out about these benefits NOT to do something about it.
...but you can't make him take his Toprol XL.
My girlfriends Grandparents said they went on the Part D plan and the cost of their medications has increased dramatically. I'll need to remind them that they don't have to use Part D, unless you're stuck on it once you start.
I knew this was a bad plan from the beginning.
Sheez. The rules must have been written by the same people who write the tax code.
Republican President+Republican Congress=New Entitlement Program
New math.
That's what my mom said. Too damn confusing.
Actually, depending on the individuals LICS (low income subsidy), the statement is absolutely correct. Depending on the LICS, there can be a zero premium, zero deductible, and no true out-of-pocket limit. In otherwords, zero cost across the board.
Sounds normal, I'm with them.
It's a medical plan written by lawyers.
Unfortunately, you want the medicine to work. That requires research which costs money. And if it doesn't work, the lawyers suck more money from the system.
Here in California, Arnold designated 15 million to help out until things got sorted out. Seniors were complaining every which way according to the news. I don't like it that we even HAVE this program, but its here and there is no reason why people should be confused.
I did the research, signed my mother up for a plan...her drugs are waaaaaya cheaper (thanks to the taxpayers) and we also have coverage after the 2250 is reached.
It took my wife several hours to figure it out for my mother. And my wife has worked with insurance/human resources for 15 years. There is no way my 78 year old mother could figure it out.
"....they don't have to use Part D, unless you're stuck on it once you start."
Thats the secret.....they are under NO obligation to get all of their meds thru the Part D provider.....this plan is useful only if someone actively manages it.
My revelation led me to decide to buy my Mothers generics as a straight-up walk-in at a local pharmacy, using only her AARP discount card........and to use the "Plan D" program to mail-order her very expensive bob-generics.......the 2250 limit is severely compromised if you allow the "total cost" of the generics to be tabulated into the 2250 at top-dollar-retail. Big deal if she pats 25 at a pharmacy instead of 4 thru part D but has 200 or more tacked onto the accumulating 2250.
bob-generics
non-generics......damn b is too close to the n, LOL
I believe this is the biggest mistake Pres. Bush has made.
The second biggest was letting the swimmer write the education bill.
I don't believe that for a second. With the advertising blitz on TV, Radio, and Print media, plus several retailers and pharmesuitical companies also joining in the quest to educate these folks - I will chalk it up to just a few reasons:
1. Don't care/ are not interested - many of these are folks who just hate change. They woldn't sign up if it meant totally free medications because it would require change, and maybe some paperwork.
2. Folks who are too hard-headed. They have been told about it, and just don't get off their lazy butts to do something about it.
3. There are even a few who intentionally don't sign up because they feel the Government has no obligation to pay for their medications - as they can afford them anyway.
I truly believe that the actual number that can HONESTLY say they don't know about it is less than 3% of those eligible. The number that can honestly claim to "know how to apply" might number up to 5% (that would be those who don't get to Wal-Mart or any other public place, and don't pay any attention whatsoever to any media sources at all).
I don't believe that for a second. With the advertising blitz on TV, Radio, and Print media, plus several retailers and pharmesuitical companies also joining in the quest to educate these folks - I will chalk it up to just a few reasons:
1. Don't care/ are not interested - many of these are folks who just hate change. They woldn't sign up if it meant totally free medications because it would require change, and maybe some paperwork.
2. Folks who are too hard-headed. They have been told about it, and just don't get off their lazy butts to do something about it.
3. There are even a few who intentionally don't sign up because they feel the Government has no obligation to pay for their medications - as they can afford them anyway.
I truly believe that the actual number that can HONESTLY say they don't know about it is less than 3% of those eligible. The number that can honestly claim to "know how to apply" might number up to 5% (that would be those who don't get to Wal-Mart or any other public place, and don't pay any attention whatsoever to any media sources at all).
If you pay for all your healthcare out of pocket, or receive it as a benefit from where you work, then I'd say you have a point in wanting transparent and efficient service.
If however, you're getting this service from the government, I would think the least you could do is go along with the program.
i agree!!!!!!!!!
I'll try and remember that. I'm far too young for such a program. I'm betting that by time I'm there we'll have a national health-care system in place.
Bump for later.
I take 10mg of Toprol daily, I have Medicare Part A and Part B plus I am covered by my wife's health plan.
The annual information letter from the plan advised us that I should not sign up as it would save me no money over the 50% discount already in the plan.
There may be many like us.
I checked the AARP site and checked 4 medications and the estimated cost was in excess of $3,068 per year.
That's got to be near the retail cost!
Thank God I can get them for $336 because of VA eligability.
There are many with Medicare supplement plans for whom Part D is not the right choice. If that's your situation, good for you.
More aptly, you should state you can lead a horse to the ocean. That's how deep the water supply would need to be.
I hope this plan falls flat on it's insidious face.
"I take 10mg of Toprol daily, I have Medicare Part A and Part B plus I am covered by my wife's health plan.
The annual information letter from the plan advised us that I should not sign up as it would save me no money over the 50% discount already in the plan. "
I take a motherload of meds, 2 out of 11 are generic. I am as are you on parts A & B plus covered by my health plan as number 2. Got the same letter.
Try to look at it this way, if you live another 7 years or so, most of your drugs will be generic!
The person who wrote this article needs to actually take a look at Medicare Part D before writing some of this tripe.
Another complicating factor is the lack of information from current providers and sources of medications. I made some inquiries for an elderly family member who currently receives medications through pharmaceutical companies' charitable programs. These companies were unsure how their programs would be affected. It's hard to run the numbers when you can't get any to work with.
It seems a lot of people here are "blaming the victims" for this nightmare government program.
No, it was not the seniors, for the most part, who were confused NOR why Schwarzenegger had to devote those millions, BUT THE INTERMEDIARY COMPUTER PROGRAM THAT WAS FAILING...it was not including people in the Plan even after enrolled and was spitting out preposterous denials at the cash register to Medicare enrolless advising them they owed "$3,500." or some such nonsense for a $13.00 generic refill and similar monstrosities.
What was occuring was that MEDICAID people were not receiving their MEDICAID priced refills and most of them really needed what they were taking uninterruptedly, and thus, the state had to intervene and "emergency fund" the Medicaid pharmacy costs until the Federal computer system was organized and corrected.
THE PLAN ITSELF CREATED THE PROBLEMS at the cash register for many enrollees, leaving them to go home wondering, like a lot of seniors are prone to do, "WHAT DID I DO WRONG" when, in fact, the PLAN AND THE COMPUTER SYSTEM was screwy.
Not nationwide, just in a few states that have the highest Medicaid enrolleess...California, New York, to name the two biggest problems.
And, the Plan itself has been confusing even IF the computer sytsem was workig well in that last two years, there was one "plan" for drug coverage under Medicare for some people, and that was replaced by this "new plan" January 1, which then dispensed or failed to dispense reasonably priced refills by thousands of dollars without explanation, or just refused to acknowledge people who were already enrolled correctly.
Thus, people already qualified for one plan in the last two years but now no longer do by the same income variables, combined with the huge computer problem in January, EVERYONE was confused and not because they weren't capable or able. EVEN PHARMACIES were being told to collect huge amounts of thousands of dollars for drugs that normally (even without the Plan) cost a mere few dollars.
But, it was the Medicaid numbers that required the emergency funding by some states, inorder to pay for two, three months refills for their enrollees while the federal plan (computer system) was/is being straightened out.
No, this program is too complicated to be understood. It is as bad or worse than tax code.
Excuse me???? Is that how you talk to another freeper? We are having a discussion, which I thought was adult like, but sounds like some one like you don't like other people to have a different point of view, and please remember this SIR:
MY KIDS WILL BE PAYING FOR YOUR BUTT MEDS TO!!!
Make all the old folks stand in line out in the cold and bury them in complicated forms that often say one thing on one page and the exact opposite on another page deeper into the morass.
No one completes an application..no one qualifies...no need for the program...cut the sucker...
Thats pretty much how the Clinton's cut the VA programs for many disabled Vets
If anyone out there has a strong opinion that opposes this would you please share it? My father-in-law asked me to figure out what they should do. After reading countless pages of insurance-speak and government-speak and realizing both sides were exaggerating the benefits of their point of view while ignoring the negatives, but advice to my father-in-law was to stay put. They have medicare and a Blue Cross Supplement with a decent drug prescription plan. From what I understand, once you go in to the gov't plan you can never go back. But if you have your own plan you can stay there as long as you want and just pay a penalty for joining the government plan late should you change your mind. In the vein of never buying a car on it's first model year cause the kinks aren't worked out yet, I couldn't see a reason for the parents-in-law to switch. Anyone who believes differently, PLEASE give me your opinion!! (Thanks!)
Because the msn has made this out to be a BIG confusion - I put off looking into Medicare D until now. Oh I had already called AARP who I get my supplemental thru and was not pleased with their plan. So this is what I found....today
MEDICARE ... DRUG PLAN (in Hawaii)
1. $22.85 per month premium...
2. No cost for Rx until MEDICARE has paid out $2250.00 -** except you do pay a copay of $5.00 or $28.00 or $55.00 copay depending on generic vs name brand AND your Dr can fax a request for the drug he desires & eliminate the higher copay
3. When Medicare reaches $2250.00 in drugs payouts *** then all drug will become your responsibility UNTIL costs reach $3600.00 Then Medicare will pick up 95% and you will pay 5%.
Medicare D recap
1. Monthly Premium .. $22.85
2. Copay .. $ 5.00 +
3. No deductible
4. No expense to patient until Medicare has paid out $2250.00
5. Drug expenses from $2250.00 - 3600.00 is patient responsibility.
6. From $3600.00 on with no limit Medicare pays 95% and patient pays 5% -- until the end of the year!!
Now for an AARP partnered plan ( I don't know what else to call it).
AARP Partnered Private Plan RX plan. ... Drug Plan
1. $80.00 (aprox) premium per month
2. Deductible of $250.00
3. THEN the non government program will pay 50% and you pay 50% of the RX up to $3000.00 (which includes your 50% and the $250.00 deductible). After $3000. has been paid out ALL RX pay-outs are finished or as they say here pau until the next year starts - and so does the deductible start again.
AARP Plan recap
1. $80.00 premium - aprox.
2. $250.00 deductible YOU have to reach.
3. private plan does a 50/50 with patient after deductible has been met.
4. when expenses reach $3000.00 (including the $250. ded. and include patients part of the 50/50 the coverage STOPS not to begin again until the next year.
I do not know how MEDICAL SAVINGS ACCOUNTS plays into this!!!
I don't have road rage ----- I have PHONE RAGE ....BIG TIME as one of my favorites says.
It is not complicated!! It will save me money!!!!!
Six hours later - maybe more - I got it done.
The problem is ... you are making a decision you can not up-grade, only down grade.
I don't take any Rx but still have to plan for when I might, and now will be less expensive than next year.
Slowly but surely -- "hillary care" is taking place.
You are exactly correct. I have spent the last 12 weeks in this mess. It has been impossible, with patients having signed up, but eligibility not beginning until after a phone call to the company--if you can get through. I know one New York company with the standard "all operators are busy" message that doesn't even put you on hold--it just hangs up.
As for those who say it is easy to understand, I say wrong! One pharmacist I know, who has done retail for 20 years, couldn't get her own mother enrolled and finally said, "to hell with it." If she can't figure it out, with seminar after seminar last summer and fall, then I don't expect Aunt Minnie to figure it out. The major problem was that in the seminars, no one knew what was going to happen until December. This implementation makes the post-war Iraq planning look downright prescient.
The vast majority of complaints I hear about the plan is the fact that it has choices. It's not as much confusing as it requires you to make a decision. This generation was raised on avoiding decisions.
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