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Prescription plan complicated, but it can be sorted out.

Byline: GUEST VIEWPOINT By Jerry Harden For The Register-Guard

Many Oregon seniors and disabled people are confused about the complexities wound into the new Medicare Part D prescription drug program.

Unfortunately, many authorities trying to present factual information are misstating some plan components, adding to the problem.

First, it is important to reject the concept of the "typical beneficiary." Some people will benefit greatly. Others will receive little if any benefit. And still others will be hurt by the new plan. Prospective enrollees need to consider each component of every plan being considered.

Eugene Mayor Jim Torrey's reference in a Nov. 15 guest viewpoint to the "typical beneficiary" applies if monthly drug costs are about $200. People paying $30 per month will actually have higher out-of-pocket costs than if they had no program. People paying $500 per month will experience a savings of about 33 percent.

The new drug plan will pay 95 percent of drug costs in excess of $5,100. It is people with catastrophic needs who will benefit the most.

Exercising the option of not enrolling may or may not be a good strategy, due to the penalty element of the program. A plan with low monthly premiums may prove more expensive than a plan with higher premiums, but with less expensive copays.

I am concerned that Torrey implies that the new program is a fine example of free enterprise. He states, "As a result of strong competition, Oregon's Medicare recipients can select from a wide array of options. ..." A more honest statement might be: As a result of strong competition and influence peddling in the halls of Congress, Oregon's Medicare recipients are forced to negotiate a complicated, complex and confusing program beyond the comprehension of most seniors.

New York Times columnist Paul Krugman wrote (Register-Guard, Nov. 21): "The Medicare drug benefit is an example of gratuitous privatization on a grand scale, ... and the result ... is a piece of legislation so bad it's almost surreal."

Torrey fails to address the new plan's most important weakness - how it treats Medicaid recipients.

Effective Jan. 1, Medicaid will provide only limited no-charge prescription drugs for anyone, except for those in nursing homes. Starting next year, most Medicaid recipients will be required to make copayments of $1 or $3 per prescription per month. It is not uncommon for some Medicaid recipients to require a dozen drugs or more every day. Their new monthly expenses in 2006 may be $20 or more.

Medicaid residents of assisted living facilities receive about $122 per month to pay for personal products, hair care, cable TV, The Register-Guard, pet food - and the list goes on. These people are already stretched to the limit. To now advise them that their monthly costs will go up $20 to pay for copays, for example, is a truly bitter pill to swallow (pun intended).

To obtain their medicine, they will have to give up something important to them such as their TV, their pet, etc. Financially secure enrollees will save hundreds, even thousands, of dollars. Why do the wealthy win, and the poorest of the poor lose?

An important issue, now being ignored, is the fact that Medicaid residents will be required to make their copays literally out of pocket. Many such residents are experiencing dementia and can't remember their room number, much less where they put their money. Facilities are now facing the task of working out a system of cash control for residents.

Some confusion exists about deadlines. It is possible to delay enrolling until May 15, 2006. However, no benefits will be available until the first day of the month following enrollment. Therefore, the most important deadline is Dec. 31. This is not a postmark deadline. It is important to allow at least one full week for mail delivery and processing by the selected plan.

Help in understanding the new program may be obtained by calling the Medicare Access Network toll-free at (866) 329-0514. You will be advised about community-based group sessions leading to enrollment.

The Oregon Health Insurance Benefits Assistance Program can be contacted at (800) 722-4134. Ignore the prompt to enter your ZIP code and enter "0." One-on-one assistance in community locations is available. Limited in-home counseling may be available for people lacking transportation.

The Oregon Department of Human Resources has a hot line at (877) 585-0007. Contact Medicare for information or to enroll at (800) 633-4227 or online at www.medicare.gov.

Jerry Harden (mail4jah@clearwire .net) lives in a seniors-only community and is active in a variety of programs providing service to senior citizens.
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Title Annotation:Commentary
Publication:The Register-Guard (Eugene, OR)
Date:Dec 9, 2005
Words:761
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