Talking Health

        Imagine this: Mrs. G has been prescribed various medications for her arthritis, cholesterol, and diabetes through her Medicare Advantage Part D Drug Coverage.  Her plan through United Health covers approximately two-thirds of the costs of her drugs.  By mid-year, she has already paid $900 for her prescriptions.   The total costs of her drugs at this point has reached $2,700, which means she has to now pay 100% of the costs.  The drug company will not provide any more coverage until the total drug costs reach $5,100, at which point the plan’s catastrophic coverage kicks in covering 95% of her costs.  This gap in coverage is known as the “doughnut hole.” 

            “It exists to save money,” said Peter Precht, Director of Policy and Communications at the Medicare Rights Center.  The government and private insurers devised the system to limit their costs in covering prescription drugs for senior citizens.  The catastrophic insurance kicks in as a safety net for seniors who have exorbitant expenses. 

            United Health’s Medicare Advantage plan also consists of an assortment of copayments, deductibles, and premiums.  By the end of the year, the total cost of Mrs. G’s prescription drugs will have amounted to $5,400, and she will have paid $4,024. 

            Confused? Millions of Medicare beneficiaries surely are, compounded by the fact that Medicare Advantage plans don’t provide coverage for the same drugs and have different deductibles and premiums. As a consumer hotline representative at the Medicare Rights Center stated, “Medicare covers only 80% of the costs.  Added costs add up for many senior citizens.” Moreover, switching to another plan with lower premiums and more comprehensive drug coverage is difficult to do: enrollment is available on a yearly basis, and special enrollment is only granted for extenuating circumstances, which do not include a plan’s discontinuation of coverage for a particular drug.

            While much press has been given to President Obama’s $634 billion dollar reserve fund that will promote health care reform over a span of 10 years, including a $20 billion expenditure on Electronic Medical Records (EMRs), very little attention has been given to any time of reform for Part D Drug Coverage.  Wealthy beneficiaries of Medicare who make more than $85,000 annually would be expected to pay more for premiums for their drug coverage starting in 2011, while cutbacks in government spending on Medicare Advantage Plans will be enacted. Such changes seem rather abstract and superfluous at best, and what would they accomplish? Drug costs would still be through the roof for most senior and disabled citizens, who pay inordinate amounts out of pocket and are not even covered for mental calamities such as anxiety or depression under Medicare. Until private insurance companies such as Medicare Advantage plans are out of the picture, and drug coverage plans become an integral part of Original Medicare, will there truly be respite for beneficiaries of Medicare. 

Further questions we would like answered as the semester progresses include:

1)    Shouldn’t the stimulus plan be targeting drug companies for over-priced drugs?

2)    How is taxing a small minority of wealthy Medicare beneficiaries going to lower the costs of premiums, deductibles, and the costs of drugs not covered by Medicare for the majority of senior citizens and disabled persons?

3)    Why are there such stringent eligibility requirements enacted for Extra/Partial Help coverage for Medicare beneficiaries who can’t afford the coverage gap or “donut hole” provided through Social Security? Why are senior citizens being disqualified for their assets?

4)    Why is so much emphasis being placed on Electronic Medical Records (EMRs) when citizens cannot afford their medications or insurance plans?