Sign-up Deadline Looms

The Medicare Prescription Drug Plan

Plan D—Does that Stand for “Dumb?”

                              By Edward Shanahan

 The session at the Clarion Inn in Northampton lasted more than two hours yet, at the end, most of us had only the most tenuous handle on how the new Medicare prescription drug plan (Part D) works and what choices we faced us before enrolling.

  Melanie Miller of Florence, who works for Blue Cross-Blue Shield of Massachusetts, is very good at her job – explaining all of the intricacies of various health insurance coverage plans – Medicare A and B, Medigap coverage and its three levels – Core, Bronze, and Gold, not to mention BlueCare 65, Medicare PPO Blue, either in network or out of network, not to mention the deductible and co-insurance requirements, and this is only for Blue Cross-Blue Shield enrollees.

 But as good as Miller is at her job – and this is the second time we have participated in one of her sessions – two years earlier she was immensely helpful in refining our choices for hospital and physician insurance coverage—at times, she seemed to admit the Part D drug programs remains confusing, even baffling, even impenetrable.

 There were times during her presentation when I could only shake my head and pretend to be amused  at the absurdity and needless complexity of Part D (where is Part C in the Medicare universe?).

 But this is no laughing matter, this is serious business for millions of Americans who are being impoverished by the high cost of prescription drugs, and who might look to the government to offer some answers and some financial help. That’s actually what some governments are created to do – be helpful.

 But instead, the Administration and the Congress concluded that direct government prescription drug benefits paid for by taxes and premiums would be too much like socialism. Better to let the private insurance companies, our good friends, Aetna, Cigna and Humana—with their long tradition of caring and compassion— actually provide the coverage.

  So we now are encouraged to shop around at the Stop and Shop pharmacy or at the CVS store to find out what insurance company provides the best benefits at the most favorable cost. In some states up to 40 firms will be trying to get your business, so there are lots of choices. Then we can deal with each of the companies individually.  Thanks a lot.

 As one pharmacist told the New York Times: “The program is so poorly designed and is creating such much confusion that it’s having a negative effect on most beneficiaries. It’s making people cynical about the whole process, the new program, the government’s help.”

 And you will, of course, recall that it was the support of this disaster by the AARP that pushed it over the top in 2003 and in the process resulted in the wholesale defections of thousands of AARP members (including me, who cut up my AARP card and shipped it off to AARP headquarters). We believed the lobby for retirees had sold out to the Bush Administration and the insurance and drug goliaths. A few months after passage of the drug bill, the AARP leadership decided it had been wrong—the Part D plan was bad for the elderly. What a surprise.

 It is only now with a deadline looming for signing up for Part D that we realize how bad the program really is—not just because of the mindless confusion and complexity, but, after the enrollees and the government throw a ton of money at the insurance and drug companies, the resulting benefits stink, as a consequence of co-payments, deductibles, and huge gaps, especially for those whose prescription drug expenses are the greatest.

 For example, after your drug expense reaches $2,250 in a year, there will be no Medicare benefit until your cumulative costs then hit $5,100—so, for the $2,850 in between, you are on your own, it comes out of your pocket. Now, that’s cynical. The program is fine for those with no or low drug costs, but are largely no help for those  who actually need assistance the most.

  Oh, and then I asked whether Blue Cross-Blue Shield—should I enroll in their drug program—would reimburse me for the cost of the prescription  drug I get from a pharmacy in Manitoba, Canada, which is so much cheaper than the same drug bought in this country. In a word: no, according to Melanie Miller.