Sunday, November 30, 2008

Medicare D and The Gap

Editor,
November 15 until December 31 is the open enrollment period for Medicare’s Prescription Drug program. The best holiday gift we can give a senior relative or friend is to assist them in determining whether the program they are currently enrolled in is the best one for them. The simple way to do this is to go to www.medicare.gov and use the “Prescription Drug Plan Finder”. As we work to help our friends and relatives in this somewhat complicated process, there are three very important things to remember: 1. Use the $4 prescription drug plans offered by Wal-Mart, CVS, Walgreen, Costco and others. These plans cover generic drugs and all you need to give the pharmacist is your doctor’s prescription. Therefore they are not used to calculate the costs that get you to the “Gap” or “donut hole”, which is $2700 this year. Even though your Medicare D plan covers these generics, their full retail value is used to calculate the Gap costs. Do not use Medicare D to cover drugs you can get just as cheaply elsewhere! 2. Make sure your doctor prescribes generics whenever possible. Do no be afraid to ask for a generic. There are currently generics for cholesterol lowering, blood pressure, etc. etc. Get a generic whenever possible! 3. Use mail order for buying your Medicare D drugs. This alone can save hundreds of dollars a year and delay the time to get to the Gap since mail order drugs have a lower retail value than drugs bought in a retail pharmacy. Ask your doctor for a 90 day prescription for mail order purposes.
This year, it is more important than the past three years to re-evaluate your Medicare D program because many premiums have increased more than 30% and many plans have changed their formularies and no longer cover certain brand drugs they covered before.
Ed Maxwell

Tuesday, November 11, 2008

Letter to the Editor of the Springfield MA Republican

The Medicare Prescription Drug program, put into law by President Bush and a Republican Congress in 2003, has been operational since January 2006. This program in 2009 has had several substantial changes. First, premiums have increased from an average of $20 a month in 2006 to an average of $40 a month in 2009. Adding insult to injury, the drugs covered by the insurance companies (the “formularies”) have been reduced to the point they only cover generics, with few exceptions. When the program began in 2006, most companies covered Medicare recipients in the “gap” or "Donut Hole"; now very very few of the insurance companies provide any gap coverage and then only for a few very inexpensive generics.
The Medicare D program is a prime example of a good idea gone bad: insurance companies, driven by the need for profits over all, are denying essential benefits to the most senior members of our society. It has long been talked about in the press about seniors trying to make a decision between food and fuel. Now a third factor has been added: making a decision between food, fuel and life-saving drugs. Make no mistake, in 2009 this is going to be a serious, serious issue. President Bush's Prescription Drug Program would have worked only if the CEO’s of our insurance corporations cared about taking care of our senior citizens rather than taking care of their stockholders. Notices are now being sent out by Medicare insurers with announcements of increased premiums. Hidden beneath these increased premiums is the fact that many, many drugs that they covered in 2008 are no longer covered. Open enrollment begins November 15. Everyone affected by this program needs to look at their coverage and check out the alternatives on the Medicare website: www.medicare.gov.

Saturday, November 01, 2008

The Medicare D "Gap" for 2009

The Gap for 2009 is reached at $2700. That means that when the total retail costs of all your drugs reaches $2700, you are responsible for 100% of the costs of the drugs until you spend about $3000 of your own money; then catastrophic coverage kicks in and your costs will drop dramatically. The only way to calculate when you'll reach the Gap is to know the retail cost of your drugs. You can find these on www.medicare.gov or on the website of your Prescription D Insurance provider. If you have 3 medications and the retail price of these medications average $300, then it would take 3 months to reach the Gap. Then you would pay the full $300 for each of these drugs ($900 a month), for 3 and a half months, at which point you would enter catastrophic coverage (in August) and the prices would drop drastically to a few dollars a month for the rest of the year.

Wal-Mart $4 Prescription Drugs

I have added a link to Wal-Mart $4 prescription drugs. This list is a very very important way to lower Medicare D costs and lengthen the time before going into the Gap. Download this list, print it and bring it to your doctor and ask him or her to look at your prescriptions and look at the Wal-Mart list and see if any of your drugs can be changed to those on the list. Wal-Mart will give you a three month supply of drugs, if they're on the list, for $10. And you don't need to use your insurance card to get the drugs and they won't count against your out of pocket expenses and they won't bring you closer to the Gap. If you can keep some of your drugs out of the Medicare D program, by buying them at Wal-Mart, then you may delay or avoid having to reach the Gap. Every drug you can buy through the Wal-Mart $4 program, you should buy. It's that simple.

Medicare D in 2009

The Medicare Prescription Drug program, put into law by President Bush and a Republican Congress in 2003, has been operational since January 2006. This program in 2009 has had several substantial changes. First, premiums have increased from an average of $20 a month in 2006 to an average of $40 a month in 2009. Adding insult to injury, the drugs covered by the insurance companies (the “formularies”) have been reduced to the point they only cover generics, with few exceptions. When the program began in 2006, most companies covered Medicare recipients in the “gap” or "Donut Hole"; now very very few of the insurance companies provide any gap coverage and then only for a few very inexpensive generics.
The Medicare D program is a prime example of a good idea gone bad: insurance companies whose only interests are denying essential benefits to the most senior members of our society. It has long been talked about in the press about seniors trying to make a decision between food and fuel. Now a third factor has been added: making a decision between food, fuel and life-saving drugs. Make no mistake, in 2009 this is going to be a serious, serious issue. President Bush's Prescription Drug Program would have worked only if the CEO’s of our insurance corporations cared about taking care of our senior citizens rather than taking care of their stockholders. Notices are now being sent out by Medicare insurers with announcements of increased premiums. Hidden beneath these increased premiums is the fact that many, many drugs that they covered in 2008 are no longer covered. Open enrollment begins November 15. Everyone affected by this program needs to look at their coverage and check out the alternatives on the Medicare website: www.medicare.gov.

Thursday, March 16, 2006

Bush is right

President Bush is right. The new Medicare D program does save people money. However, it takes at least two hours of work on the computer on the medicare.gov website to get someone signed up to the proper insurer. There are so many issues to resolve during the signup process: are the drugs covered by the insurer; can the recipient afford a deductible; does the recipient qualify for state assistance? It's a good program that is simply too difficult to get into.

Sunday, January 22, 2006

Deducting the premium from your Social Security

When you enroll in Medicare D, you have an option to deduct the premium automatically from social security, or make the monthly payment to the insurance carrier. My original thought was that, until the program gets straightened out, you should make the payment directly rather than have it deducted. However, I have been dealing with people who may not be capable of making this monthly payment--may forget to make it. The consequences of this are not good. It was pointed out in a comment to this blog (by Yvonne) that that could happen. I agree. Assessment must be made of the enrollee's capability of making monthly payments on their own. If there is any doubt that the payment would be made regularly and on time, then the payment should be deducted from the Social Security check.

Saturday, January 21, 2006

Drug "Not on Formulary"

When you do a drug plan search on the medicare.gov website, sometimes the insurer may state that your drug is "not on the formulary". In such a case, you will pay "retail" price and the payment will not count toward your $2250 total retail drug costs--that is, it will not help you reach the gap or get through the gap. One individual that I helped was paying cash for his drugs and was using two drugs that were "not on the formulary" of any carrier. The so-called "retail" price that the carrier was charging for this drug was almost $12.00. The individual who had been paying cash had been paying almost $100 for the drug. We took the printout from the website to the pharmacist and he said, in effect, there are two "retail" prices: one is for cash paying customers, which can be up to ten times the "retail" price that the pharmaceutical company charges the pharmacy. Just by joining a plan, this individual will save $85 a month even if the drug is not on the carrier's formulary. Figure that!!!!

Thursday, January 19, 2006

medicare.gov website really works

Tonight we helped 9 seniors at the local public library navigate through the medicare.gov website. Overall we probably saved this group of people more than $5000 a year in prescription drug costs. It's a very difficult program to figure out, but there's no doubt about the benefits. We had 9 seniors and 5 volunteers and it took two and a half hours on 9 computers to help them all out. Do the math: 30,000,000 seniors that need to be on Medicare D, 2 hours each to get them on the right program: 60,000,000 hours of work for someone. There is only one good solution: spend two hours on the medicare.gov website to work through all the options.