Medicare Part D: Still “a Lot of ’Splaining to Do”

Fred and Ethel Mertz, of “I Love Lucy” fame, have been resurrected as TV spokespersons to market Medicare’s groundbreaking prescription drug plan for seniors. However, a special report on Medpage Today regarding the Medicare Part D plan chides that these characters are “a good choice because, as Ricky would say, Medicare has ‘a lot of ’splaining to do.’” In a recently distributed handbook, the Centers for Medicare & Medicaid Services (CMS) misstated the enrollment eligibility for the Medicare-approved regional prescription drug plans (PDPs) for low-income seniors—the very group the plan was designed to serve. According to CMS, the correct information is posted on the Medicare website; however, the website is reported to contain other inaccuracies. Medpage Today states, “This single case may be an exception, but critics of the Medicare prescription drug plan say they suspect otherwise.”

Comments

[Elaine L. Towle, CMPE]

In the next few weeks we will see a real media blitz on Part D and we will all be getting lots of questions from our patients. CMS has provided some great patient resources on their website but this decision is going to be very challenging for most patients, even for those comfortable with researching on the internet. CMS has said that there will also be resources available locally in every state - your staff may want to explore these resources to pass along to patients who need help. Good luck!

[Pawan Arya]

I having studied the Medicare Part D Program, do not think that it is either ground breaking or of much use to the senior citizens for a number of reasons:
1. It requires enrollment for a fee.
2. Plethora of plans that will be available, which in turn will have different Formularies is not helpful in anyway. The senior citizens, who most often do not know the difference between Medicare and Medicare HMO, will find it mind-boggling and over whelming to deal with.
3. It appears average cost of enrolment would be $35.00 being little less for cheaper plans and higher of better plans, meaning that individual will have to shell out $420.00 whether you use it or you do not. In addition there is surcharge for late enrolment, meaning that those who would like to wait and see how the program works, get punished for failing to fall in line.
4. In addition the $250.00 deductible means that one would be paying at least $700.00, whether one uses or not. Therefore anyone who does not require ongoing medication that costs more than $60.00 is not worth enrolling.
5. After $250.00 deductible the beneficiary will need to pay 25% up to max $500.00, meaning that the beneficiary would shell out at the very least $1200.00 to have maximum benefit of $2250.00 limit.
6. Most beneficiaries will fall though the doughnut hole. Meaning that to gain the benefit over $5100.00 limit, one would have to spend $4000.00 Therefore the actual benefit is only $1000.00 for a person who will require drugs that cost over $5000.00.

The question is how many beneficiaries will go over this limit and actually benefit fro this and at what cost? The cost of administration, publicity, and education will far out reach the benefits.

Some financial wizardry! ! !