Just who stands to gain? The insurance companies, for one.
Part D was created when Congress voted the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) into lumbering life. Ostensibly, it enabled seniors, the disabled and low-income people, to buy prescription drugs cheaply. Actually, it doesn’t cover that much, and Part D has essentially turned over what it does cover to private insurers.
The Gray Panthers around me, a mix of old, not-so-old and relatively young, belonged to the activist group founded in the late 1970s for elders with a gripe against unfair treatment of the old. Today’s Panthers have broadened that mandate to include all ages.
Part D was created when Congress voted the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) into lumbering life. Ostensibly, it enabled seniors, the disabled and low-income people, to buy prescription drugs cheaply. Actually, it doesn’t cover that much, and Part D has essentially turned over what it does cover to private insurers. The insurers will administer the program for a per-member fee paid by Medicare. The options include relatively comprehensive Health Maintenance Organizations (HMOs) and “stand-alone” drugs-only plans (large areas of the country are not covered by HMOs).
If this handover to private firms weren’t enough to rile a Panther, the MMA makes it absurdly complex to choose a plan, so confusing are the feds’ rules and the insurers’ hedges and restrictions. There is no uniformity among private plans and an aspiring Part D member has to wade through a morass of rules and lists even to begin to understand what each plan offers and how to enroll.
The pharmaceutical industry, even more than insurers, can raise its prices as much as it likes, whenever it likes. This means that Alice, Carlos, and an army of Medicare enrollees are completely unprotected from sudden drug price jumps.
The feds can also waive some privacy protections (just which ones is still not clear). Marsha, who has Hepatitis C (and spends a bundle on drugs) is not enthusiastic about sharing her medical history with big insurance, but she needs the meds.
Aimee, who has multiple sclerosis, pays the Part D deductible of $250, then 25 percent of her drug costs up to $2,250. After that Medicare snaps its purse shut and she has on her own until she’s racked up $5,000 in drugs. That’s a $2,750 gap for which she’s wholly responsible. Granted, Medicare covers all amounts above $5,000 generously. Still, Aimee lives on a limited income, and wonders where the $2,750 will come from.
The framing of the MMA makes it so difficult to follow, its instructions so complicated, that even experts disagree about it. No wonder, Elvis, Aimee, et al. are dazed and worried. There are dim rays of light. Help is available for low-income clients, but the basic $600 break offered them won’t go far with expensive drugs needed for chronic illnesses. Additional help is available for low- and moderate-income people (see box), but it takes some searching among myriad services, government agencies and private organizations.
Just who stands to gain? The insurance companies, for one. My HMO – pretty typical – received $72 a month this year from Medicare just for keeping me on its books. Next year they’ll get $88, plus whatever they and Medicare agree on for Part D. That multiplied by, say, 3,000 members comes to a nice piece of change.
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