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By John M. Bigler THE MEDICARE Modernization Act of 2003 authorized for the first time prescription drug coverage for Medicare recipients.
People who already have coverage should have already received a notice in the mail from their insurance company indicating whether the coverage they have is "creditable" under the new law or "not creditable", meaning that they would have to choose a new policy or be subject to fines at a later date should they choose after the deadline. Should any beneficiary fail to choose a policy before the deadline - right now May 15 - and then choose a Medicare prescription policy after the deadline, they will be subject to a penalty each month for the rest of their lives.
Supposedly, the purpose of the new law was to give everyone on Medicare the same type of prescription coverage that Congress has. This law clearly falls far short of that goal. As it stands now, the policies that will be sold for the most part will have a $250 deductible for prescriptions. For the next $2,000 in prescription cost, the beneficiary will be responsible for $500. After $2,250 has been paid, the beneficiary will be responsible for the entire cost of prescriptions from $2,251 to $5,100. After that, Medicare will pick up the balance of the cost with a copayment by the beneficiary, typically of 5%. That gap in coverage up to $5,100 is known as the "donut hole" and you can be quite sure that your local congressman does not have such a donut hole in his or her coverage.
There are numerous other problems. One of the most serious is that each company will have its own formulary or list of drugs that they will cover. Each company can have different formularies. The most dangerous part of the formulary is that insurance companies will be allowed to change their list of drugs whenever they wish and as often as they wish. However, beneficiaries will only be able to change their plan once a year. I pity the poor beneficiary who is reliant on a particular medication only to find out that the company that he chose has decided to no longer include that drug in its formulary and the beneficiary still has eight or nine months before he can make a change. There are appeals rights built into the law, but one wonders how long the appeal will take and whether the beneficiary will be around to benefit from a favorable decision.
Another problem for consumers is picking the proper plan. In New York there are hundreds of different plans and most beneficiaries are being bombarded with announcements from all the different companies who have already benefited significantly from the subsidies that they receive from the government to agree to participate in the plans.
How to choose? My experience is most pharmacists are doing a yeoman's job in attempting to assist their customers. However, this is outside the scope of the pharmacists' normal duties and the amount of information, even for the pharmacist, can be overwhelming, especially combined with their normal pharmaceutical tasks. The Internet can be helpful. The website Medicare.gov can provide information regarding plans for particular beneficiaries who are taking particular medication. However, even on the website, the amount of plans can be truly overwhelming. I have called various companies providing plans with specific questions and have found that for the most part, the people answering the phone typically are not very enlightening.
For low-income people receiving Medicaid, the change to Medicare Part D can be a dangerous one. Most Medicaid beneficiaries were randomly assigned to insurance companies. These "duel eligibles" might have been assigned unknowingly to a company that doesn't cover the prescription medication they need. As well, many of these people did not receive identification cards or information regarding the prescription plans for a number of months.
Some studies show that for people who are chronically ill and requiring a great deal of medication, this new plan may be of assistance. However, there is so much more that could have been done to assist Medicare beneficiaries with their prescription coverage. In my opinion, this plan, which prohibits the Department of Health and Human Services from negotiating with insurance and pharmaceutical companies on behalf of beneficiaries, is part of a disturbing trend under this administration to allow private companies to control benefits that used to be protected by the federal government.
Reprinted with permission of the Suffolk Times © 2006 [ Contact Us ] [ Guestbook ] [ Email ]  The Law Offices of John M. Bigler, Attorney At Law 1421 Wantagh Avenue, Wantagh, New York 11793-2206 1-888-ELDER-LAW · 516-409-6565 · Fax: 516-409-6522 E-Mail: info@biglerlaw.com · Web Site: www.biglerlaw.com |
As of November 15, 2005, anyone eligible for Medicare - those 65 or over or receiving Social Security disability for at least two years - was required to make an important decision regarding prescription coverage. Each individual will have to decide by May 15, 2006 whether they would keep the coverage they already have or elect a new prescription coverage plan under the Medicare guidelines. It is safe to say that so far the new law has been an unmitigated disaster. Supporters of the law will argue that any time a new law goes into effect, a certain adjustment period is required. In fact, this law has been so confusing that there is serious talk in Congress of extending the deadline to choose until December 31.