The coverage of the new Medicare drug plan starts January 1, 2006. Many older people feel confused and worried about this plan. Here are some of the pitfalls associated with this plan that people who are eligible to receive help from Medicare want to know about.
1. To join the Medicare Prescription Drug Plan (Medicare Part D), you must select one prescription drug plan from dozens of plans that are available (up to 50 plans exist in some states). After you choose a plan, you are “locked” until the registration period next year.
2. Suppliers of prescription drugs (PDP) may at any time change the details of their plans with a short warning period for those who plan to pay. These changes may include changes that are covered by the plan, which pharmacies are on the plan’s network, the cost of being part of the plan, and any other details of the plan. These changes are at the discretion of the plan administrator and can be implemented at any time.
3. In 2006, as soon as you used drugs in the amount of $ 2,250, you are 100% responsible for paying the total amount of the drug until you reach a coverage limit of $ 5,100. This range of $ 2,250 to $ 5,100, where you must pay for 100% of your drug costs, is known as the “donut hole”.
4. With a maximum level of savings, Medicare provides 49% savings. This is 7% better than the average savings in a licensed Canadian pharmacy. This biggest savings occurs when people spend exactly $ 2,250 on treatment for one year (if you spend more or less than your savings decrease). This means that the largest savings for Medicare can exceed the average savings of a Canadian pharmacy - $ 157.50 per year (7% from $ 2,250) or $ 13.13 per month. Is $ 13 a month at the risk of "locking up" to pay monthly premiums for a plan that can be included by you at any time. (Note. Some people can save more than 49% if they spend more than $ 7,100 per year.
5. If you do not sign up for a Medicare prescription drug plan before May 15, 2006, you will be penalized with a total 1% increase in your premiums for each month you don’t enroll in the plan after this date. This punishment is the government’s way of getting people who really don’t need a drug plan to join the plan and thus “subsidize” Medicare. 1% of the average plan is 32 cents. So every month after March 15, 2006, when people are not in the plan, 32 cents will be added to your monthly premium or mostly $ 1 for every 3 months when you are not joining. However, this penalty applies to your premium for all future monthly premiums. Many groups of older people want people to wait until May 15, 2006, and then join the cheapest possible plan (about $ 10 a month) and still order medicines from a licensed Canadian pharmacy, such as Universal Drugstore.
6. It is expected that the average monthly premiums, annual deductibles and unplanned spending limits will increase every year. This means that you have to spend more and more money every year when you are part of a Medicare vacation plan.
7. If you do not spend more than $ 800 on drugs in 2006, there is no real savings with the Medicare drug plan. This requires a minimum amount of expenses for the accumulation of savings, will grow every year, as the annual deductibles, monthly insurance premiums and spending limits outside the pocket also increase every year.
8. It will be extremely time-consuming and difficult to decipher the many plans available in each state (they all provide different coverage), and try to figure out which plan is best for you personally. This will be twice as difficult for the couple, since the prescription drugs used by each person in the couple will be different, and therefore they may require different plans. Even when a plan is chosen, there is still a risk of changing the plan after you have made a decision and you are “locked”.
9. Pharmaceutical companies have to give a lot of money from Medicare. That's why they spend millions of dollars lobbying to pass a law passed to make Medicare D a reality. That is why Senator Bill Tausin, the main advocate and motivating force associated with adopting the Medicare Prescription Drug Plan, is now $ 2 million a year at Big Pharma. On September 5, 2003, Senator John R. McCain (R-Ariz.) Said the New York Times: "I have no doubt that the pharmaceutical industry has everything you need and more," he said, "You can probably call it" Exit ticket ”,“ Without lobbyists ”.
10. Plans providers have the opportunity to negotiate better drug pricing with pharmaceutical companies, but they do not need to pass on savings to the consumer or the government.
11. If you joined the Medicare Prescription Drug Plan (PDP) any time after December 31, 2005, your coverage will not be available to you until the first day of the next month.
12. You must participate in Medicare Part D (part of the drug plan), as opposed to Medicare Parts A and B, which are automatic. You are not just credited with the best plan for you. You must wade through the piles of information to decide what is best for you.
13. It is very difficult for people who are eligible to participate in Medicare Part D to be sure that their drugs will be covered according to their formal plan (which may change any time anyway.) The form is a list of drugs covered by a specific drug plan.
14. You cannot qualify for Medicare prescription drugs if your annual income is too high or you have too many assets.
15. In different plans there will be different monthly bonuses. The plan you need can have a really high monthly premium. $ 32.20 is just a “predictable” average monthly premium.
16. Will your plan cover temporary medicines (such as antibiotics or heartburn) or only chronic medicines (such as medicines used for diabetes or heart disease)?
17. Plans with lower monthly premiums may have higher deductibles and co-payments.
18. Payments for drugs that are not included in the formula of your plan are not counted according to your out-of-payment limit.
19. Payments made under the insurance plans are not taken into account in accordance with your limit on non-payment costs
20. Is your regular pharmacy included in your pharmacy network plans? Like many people, you are likely to rely on a pharmacist who knows you and your medical conditions well. However, you may be forced to go to another pharmacy if your pharmacy is not included in your pharmacy network plans.
21. How many days of medicine can you get in due time? Do you need to constantly return to the pharmacy every month or you can get 90 days?
22. Will your drug be covered by your plan the next time you go to your pharmacy?
23. Does your plan require therapy or prior authorization? Phased therapy means using drugs in a series of steps or steps to treat your condition. For example, if you have GERD, your plan cannot cover Nexium unless you have previously tried ranitidine (Zantac) and / or omeprazole (Prilosec). Prior authorization means that for certain drugs your plan will not cover the drug without first reviewing your medical history and drugs to determine if your treatment steps were appropriate.
24. Suppliers of a prescription drug plan must allocate a lot of money from Medicare (pharmaceutical companies act as the largest investor).
25. The net cost of the state budget for benefits for Medicare drugs is estimated at $ 37.4 billion. US in 2006 to 109.2 billion dollars. USA in 2015 (as assessed by the Department of Health and Social Services). However, much higher estimates of the cost of Medicare D can also be found from non-state resources. Two years ago, Congress reliably approved a plan worth not more than $ 395 billion. Dollars for 10 years. A few months later, the cost soared to 534 billion dollars, and earlier this year it soared to 795 billion dollars. Big Pharma is the largest recipient of increased dollars added to the costs of this program.
26. A plan may force you to use generics when you use brand name drugs and cannot transfer generic versions.
27. The appeals process for some plans is very messy and confusing. (You can contact your plan if your drug is not covered.)
28. Many of the major pharmaceutical companies are now making anyone eligible for Medicare Part D, which is not eligible for assistance programs. These companies effectively force older people into a “voluntary” program that may be wrong for them. The AstraZeneca Foundation was the first to take such steps.
29. It is very difficult for many to get accurate, updated lists of which drugs will cover each plan.
30. The Medicare hotline can only answer general questions. For more specific questions, you should contact each individual insurance provider.
31. Many people waited 30 minutes or more when they called the Medicare hotline to get the necessary information.
32. Representative Dan Burton (R-Ind.) In a 60-minute segment televised on March 14, 2004, said: “Older people, when they find out that in this bill, they will be very angry. until after the next election. ”
