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Congress and the President had a golden
opportunity to make a master stroke for
Seniors. Imagine, prescription
coverage for all Medicare recipients! An
older American could rise up each day
with one less worry: at least the meds
would be covered. Finally we would have
caught up with the rest of the civilized
world in providing total care for at
least one portion of our population. The
lead weight that hung over the heads of
Seniors for so long would disappear.
Life-saving drugs could now be had by
all. For some it would mean funds are
now there to buy more nutritious foods.
For others, the thermostat could go up a
few degrees in the winter. For still
more it would mean the ability to gas up
the car, or meet the apartment rent
without fear. Perhaps the aging pet
could see the vet for the first time in
years. Just having the weight of fear
removed would add spring to the step,
and hope for the future. Seniors,
including this one, would lift up this
Republican Congress and this President
as heroes. Never mind "nucular" and "reconize."
Forget about "Abramoff", "Tom DeLay",
and "CIA agent out-ing". This
administration and this ( at the
time of passage of the program) congress
would have been elevated in the hearts
of Seniors forever.
So then,
what have they done? They have given us
Part "D". "D" is a near failing grade in
most settings, and also in this one.
At best it is a "stingy"
program for Seniors, riddled with
confusion and the opportunity for greed
on the part of insurers and drug
companies. But at least it is a
beginning toward prescription coverage;
one that perhaps can be rehabilitated.
At the worst it
becomes a government budget buster,
(the
administration said it would cost $400
billion over 10 years, while the
Congressional Budget Office says it will
be three times that amount--$1.2
trillion.) But it
still fails to meaningfully
provide the valuable medications Seniors
will need in the future. My fear
is that the drug and insurance companies
will use it as a wild, drunken party,
and the conservative elements in
Congress will kill it completely? Even
now we are hearing about huge prices
being charged Seniors for drugs
purchased in the "doughnut hole."
Previously, Seniors may have purchased
these drugs for much less at Canadian
Pharmacies (where the country actually
negotiates for lower prices), or were
offered discounts by manufacturers based
on income levels. Many drug companies
have now taken back the offer of these
discounts. So many are now at risk,
doing without critical drugs they cannot
afford in the doughnut hole, waiting for
the program to start over again each
January.
THE BASIC PLAN
So what are the basics
of Part "D"?
The bill
signed by President Bush is 411 pages long, and
takes a CIA decoding team to understand. Do we dare
try to summarize it on one page?
Under Medicare Part D, private insurance companies
(Prescription Drug Plans, called PDPs, or existing
Medicare Choice plans, which will be renamed Medicare
Advantage plans) will enter into contracts with the
Department of Health and Human Services to provide
insurance for prescription drugs. The coverage and
requirements, such as use of formulary drugs, under
the plans will vary by region to reflect differences
in provider costs and patient demo- graphics. In 2006,
the premium averaged $35 a month ($420 a year) , and
by 2010 this has gone over $40 (we estimate $500/yr).
In 2010:
(There will initially be a premium paid to a
private insurer)
These are the minimum Medicare
guidelines for the Part D Prescription Drug program.
Based on the premium you pay, your private insurer may
cover additional costs, such as deductible, and small
co-payments.
Terms of the Medicare Prescription Drug Program -
-Part "D"
*The enrollee pays a $310 yearly deductible.
* Next Medicare
pays 75 percent of drug costs of the next $2,520.00
(another $630.00 out of pocket).
*Next, the enrollee pays 100
percent of costs until total drug costs
reach $6,440.00 (another
$3,310.00 out of pocket
in the doughnut hole).
*We have now reached what
Medicare calls the "stop-loss"
threshold. From this point, thru the end of the
calendar year, Medicare pays approximately 95 percent of
your drug costs.
*That
means the Part D catastrophic protection will not
begin until the individual's total spending reaches
$4,550.00 , not counting the $500 or so annual premium.
The premium will increase over time according to a formula similar
to the one used by Medicare to regulate Part B
premiums. The Congressional Budget Office (CBO)
expects the average premium to rise from $35 to $58 a
month between 2006 and 2013.
The plan
deductible, initial benefit limit and
stop-loss threshold will each be indexed to the
growth in per capita Part D drug spending by Medicare
beneficiaries. Since such spending is expected to rise
much faster than the rate of inflation, the CBO
believes that by 2013 the Plan deductible will
increase to $466, the initial benefit limit
will rise to $4,000 and the out-of-pocket stop-loss
threshold will increase to $6,400.
The
legislation bans Medigap prescription drug policies
for anyone using Part D. As a result, many seniors
will actually spend more on drugs than they would
without Part D. Medigap policies for Parts A and B of
Medicare will remain legal.
In
order to encourage employers who already provide drug
coverage to Medicare-eligible seniors to continue
doing so, the law authorizes subsidies and tax
benefits worth an estimated $86 billion for such
employers. Public employers like the federal
government will be eligible for these subsidies,
though at the moment it is not clear who will receive them-the
FEHBP plans or employing agencies (like the USPS).
CHARTS FOR 2006, 2007, 2008,
2009, 2010
This is how it looks in Chart Form
:
2006
|
AMOUNT & ITEM |
WHAT YOU PAY |
WHAT MEDICARE PAYS |
|
$420 PREMIUMS (varies) |
$420 |
$0 |
|
$250 DEDUCTIBLE |
$250 |
$0
|
|
(25% / 75%) NEXT $2,000 |
$500 |
$1,500 |
|
$2850" DOUGHNUT HOLE"
|
$2,850 |
$0 |
|
TOTAL |
$4,020 |
$1,500 |
|
SO
UNTIL $5,520 IS SPENT, YOUR COST
IS $4,020 ($3,600 if not
counting premiums) |
|
AFTER THAT YOU PAY $2 FOR EACH
GENERIC, OR $5 FOR EACH BRAND
NAME, OR 5% OF THE
TOTAL OF EACH
PRESCRIPTION, WHICHEVER IS THE
HIGHER NUMBER. EXAMPLE: A $200
DRUG COSTS YOU $10. THIS 5%
ARRANGEMENT CONTINUES ONLY UNTIL
DECEMBER 31, 2006 |
|
ON
1/1/07 IT ALL BEGINS OVER AGAIN,
WITH HIGHER PREMIUMS AND
DEDUCTIBLE, AND A LARGER
DOUGHNUT HOLE.
Remember, if you have been in
Part D for less than a full year
in 2006, being in for a full 12
months in 2007 may mean
that the doughnut hole takes on
a greater significance for you. |
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This is how it looks in Chart
Form :
2007
|
|
AMOUNT & ITEM
|
WHAT YOU PAY |
WHAT MEDICARE PAYS |
|
$420 PREMIUMS (varies) |
$420 |
$0 |
|
$265 DEDUCTIBLE |
$265 |
$0 |
|
(25% / 75%) NEXT $2,135 |
$533.75 |
$1,601.25 |
|
$3,051.25 "DOUGHNUT HOLE"
|
$3,051.25 |
$0 |
|
TOTAL |
$4,270 |
$1,601.25 |
|
SO UNTIL $5,871.25 IS SPENT,
YOUR COST IS $4,270.00 ($3,850
if not counting premiums) |
|
AFTER THAT YOU PAY $2.15 FOR
EACH GENERIC, OR $5.35 FOR
EACH BRAND NAME, OR 5% OF
THE TOTAL OF EACH
PRESCRIPTION, WHICHEVER IS THE
HIGHER NUMBER. EXAMPLE: A $200
DRUG COSTS YOU $10.00. THIS 5%
ARRANGEMENT CONTINUES ONLY
UNTIL DECEMBER 31, 2007 |
|
ON 1/1/08 IT ALL BEGINS
OVER AGAIN, WITH HIGHER
PREMIUMS AND DEDUCTIBLE, AND A
LARGER DOUGHNUT HOLE.
Remember, if you have been in
Part D for less than a full
year in 2006, being in for a
full 12 months in 2007 may
mean that the doughnut
hole takes on a greater
significance for you. |
|
|
This is how it looks in
Chart Form :
2008 |
|
AMOUNT & ITEM
|
WHAT YOU PAY |
WHAT MEDICARE PAYS |
|
$420 PREMIUMS (varies) |
$420 |
$0 |
|
$275 DEDUCTIBLE |
$275 |
$0 |
|
(25% / 75%) NEXT $2,235 |
$558.75 |
$1,676.25 |
|
$3216.25 "DOUGHNUT HOLE"
|
$3,216.25 |
$0 |
|
TOTAL |
$4,470 |
$1,676.25 |
|
SO UNTIL $6,146.25 IS SPENT,
YOUR COST IS $4,470 ($4,050
if not counting premiums) |
|
AFTER THAT YOU PAY $2.25 FOR
EACH GENERIC, OR $5.60 FOR
EACH BRAND NAME, OR 5% OF
THE TOTAL OF EACH
PRESCRIPTION, WHICHEVER IS
THE HIGHER NUMBER. EXAMPLE:
A $200 DRUG COSTS YOU
$10.00. THIS SO-CALLED
"CATASTROPHIC COVERAGE"
CONTINUES ONLY UNTIL
DECEMBER 31, 2008 |
|
ON 1/1/09 IT ALL BEGINS OVER
AGAIN, WITH HIGHER PREMIUMS
AND DEDUCTIBLE, AND A LARGER
DOUGHNUT HOLE.
Remember, if you have been
in Part D for less than a
full year in 2007, being in
for a full 12 months in 2008 may mean that the
doughnut hole takes on a
greater significance for
you. |
|
|
This is how Part D looks
in Chart Form :
2009 |
|
AMOUNT & ITEM
|
WHAT YOU PAY |
WHAT MEDICARE PAYS |
|
$480 PREMIUMS (varies) |
$480 |
$0 |
|
$295 DEDUCTIBLE |
$295 |
$0 |
|
(25% / 75%) NEXT
$2,405 |
$601.25 |
$1803.75 |
|
$3216.25 "DOUGHNUT HOLE"
|
$3,453.75 |
$0 |
|
TOTAL |
$4,830 |
$1,803.75 |
|
SO UNTIL $6,633.75 IS SPENT,
YOUR COST IS $4,830 ($4,535 if not counting premiums) |
|
AFTER
THAT YOU PAY $2.40 FOR EACH GENERIC, OR $6.00 FOR EACH
BRAND NAME, OR 5% OF THE
TOTAL OF EACH PRESCRIPTION, WHICHEVER IS THE HIGHER
NUMBER. EXAMPLE: A $200 BRANDED DRUG COSTS YOU $10.00.
THIS SO-CALLED "CATASTROPHIC COVERAGE" CONTINUES ONLY
UNTIL DECEMBER 31, 2009 |
|
ON 1/1/10 IT ALL BEGINS
OVER AGAIN, WITH HIGHER PREMIUMS AND DEDUCTIBLE, AND A
LARGER DOUGHNUT HOLE.
Remember, if you have been in Part D for less than a full
year in 2008, being in for a full 12 months in 2009 may
mean that the doughnut hole takes on a greater
significance for you. |
|
|
|
This is how Part D looks
in Chart Form : 2010 |
|
AMOUNT & ITEM
|
WHAT YOU PAY |
WHAT MEDICARE PAYS |
|
$500 PREMIUMS (varies) |
$500 est |
$0 |
|
$310 DEDUCTIBLE |
$310 |
$0 |
|
(25% / 75%) NEXT $2,520 |
$630.00 |
$1,890.00 |
|
$3,453.75 "DOUGHNUT HOLE"
|
$3,610.00 |
$0 |
|
TOTAL |
$5,050.00 |
$1,890.00 |
|
SO UNTIL $6.940 IS SPENT, YOUR
COST IS $5,050 ($4,550 if
not counting premiums) |
|
AFTER THAT YOU PAY
$2.40 FOR EACH GENERIC, OR
$6.30 FOR EACH BRAND NAME, OR
5% OF THE
TOTAL OF EACH
PRESCRIPTION, WHICHEVER IS THE
HIGHER NUMBER. EXAMPLE: A $200
BRANDED DRUG COSTS YOU $10.00.
THIS SO-CALLED "CATASTROPHIC
COVERAGE" CONTINUES ONLY UNTIL
DECEMBER 31, 2009 |
|
ON 1/1/11 IT ALL BEGINS OVER
AGAIN, WITH HIGHER PREMIUMS
AND DEDUCTIBLE, AND A LARGER
DOUGHNUT HOLE.
Remember, if you have been in
Part D for less than a full
year in 2009, being in for a
full 12 months in 2010 may
mean that the doughnut
hole takes on a greater
significance for you. |
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THE PLAN IS INADEQUATE
Part D benefits will
cover only about one-fifth to
one-quarter of anticipated drug care
costs over the next decade. And the
peculiar "doughnut" design, with no
benefits paid for costs between $2,250
and $5,100, is confusing and costly to
many seniors. Although the plan helps
some seniors facing catastrophic drug
expenses in any given year, most will
see their out- of-pocket expenses
continue to rise since the legislation
fails to restrain sky-rocketing
pharmaceutical prices or curb the power
of the few large multinational drug
companies that dominate the marketplace.
In fact, it
actually prohibits Medicare from using
its
purchasing power to negotiate the best
prices for the elderly and
effectively
blocks the importation
of U.S.-made drugs from other countries
where prices are much
lower. (We wonder who influenced
THIS inclusion?)
HIDDEN TREACHERY?
The new law
squanders considerable resources to
bankroll privatization experiments with
Medicare Parts A & B. Despite Medicare's
record of low administrative expenses
and the failure of Medicare Choice (Part
C) in the past, the new law directs
billions in subsidies to HMOs and other
private insurers to compete for
traditional Medicare program enrollees
in six metropolitan areas. These
experiments, set to begin in 2010, and
the introduction of means-testing for
setting premiums for Medicare Part B
(higher income retirees will pay higher
premiums) have led many critics to fear
the gradual privatization of Medicare.
Do these guys really believe that
private companies will look after the
well-being of Seniors more faithfully
than Social Security or Medicare. NOT ON
YOUR LIFE! We had better get on this
fast.
PART "D" MUST BE RE-DONE
Part D has
been plagued with problems from the
start, many stemming from its
complexity. It's true that many seniors
save money with Part D, but millions of
others are worse off. And yet taxpayers
could pay nearly $1.2 TRILLION for this
benefit in the plan's first 10 years.
Congress has to do better.
There is a solution. Congress should
revamp Part D: Eliminate all the private
insurance plans, make prescription
coverage a simple, direct benefit from
Medicare and negotiate drug prices in
bulk with the pharmaceutical industry
the way the Department of Veterans
Affairs does. Under this program,
medications already cost
46% MORE than the prices the
Veterans Administration has negotiated
for its folks. I suspect that gap will
widen as lobbyists lurk around the
pocketbooks of the Congress.
YOU have the power to assure that
changes will be made in the program.
Go to the SeniorARK
"links"/"government" page. You will
see links to email the president,
senators, and your representative. They
DO pay attention to these
emails.
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