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Confused by Medicare Part D? |
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Centers for Medicare & Medicaid Services January 25, 2006 bulletin states “There is nothing in the law that prohibits a pharmaceutical company patient assistance program from providing drug assistance to Medicare beneficiaries, even those enrolled in a Medicare [Part D] prescription drug plan, but that help has to be outside the Medicare coverage – just as it has been until now. Lawful avenues exist for pharmaceutical companies and others to help Part D beneficiaries with their drug costs.” And “nothing in any Office of the Inspector General (OIG) laws, regulations, or guidance prevents pharmaceutical company patient assistance program from providing free or reduced price outpatient prescription drugs to uninsured patients and Medicare beneficiaries who have not enrolled in Part D.” Free Medicine Foundation has helped countless families across the nation completely eliminate or substantially reduce their prescription drug bills. Find out if you qualify here.
Question: Should I enroll in a new voluntary Medicare Part D Plan?
Answer: Treat this decision as if you were making a major investment, as you could stand to either save or lose thousands of dollars over the coming years.
Medicare Part D in a Nutshell
1.) Medicare Part D costs about $35 per month or $420 per year automatically deducted from your Social Security check. You will be committing yourself to at least one full year with the plan you choose..
2.) After paying the $250 deductable out of your pocket, and then 25 percent of costs up to $2,250 in total drug costs for a year. Part D will cover 75% of drug costs ONLY on the "COVERED LIST", up to $2,250. That’s $750 in out-of-pocket spending to this point. IF your Medicine is covered at all. If your medicine is NOT on the "covered list" for the plan you chose you pay for 100% of the retail cost of it.
3.) Then the dreaded “donut hole” or “gap” kicks in, and there is a $2,850 gap where recipients must pay for everything, even the $35 monthly premiums taken automatically out of your check. There is no coverage at all until out-of-pocket expenses reach $3,600. Not counting medicines "Not Covered" that you have to pay 100% retail cost.
Of the current 43.1 million Medicare beneficiaries, the governments' projections expect 29.3 million to enroll in 2006. It is expected that nearly one-half of Medicare beneficiaries will fall into the coverage "gap" or "donut hole", and those that do are still required to pay the monthly premium ($420 per year) even while they receive no direct benefit.
4.) After this you pay 5% of covered Part D costs, including medicines NOT COVERED on your Medicare Part D plan. Medicare Part D covers 95 percent of further expenses. But by this point, seniors living at a poverty-level income will be spending 41 percent of their income on prescription drugs, according to an analysis by Families USA, a health care watchdog group.
The seniors who have signed up for Part D so far say the program is "expensive, complicated and doesn't meet their needs," said Barbara Kennelly, president and chief executive officer of the National Committee to Protect and Preserve Social Security.
Drug Costs Not Lower Through Part D
As many of you have probably discovered, the new drug benefit offered through Medicare is not only confusing, it's not lowering drug costs.
A report from the House Government Reform Committee found that drug prices offered by the Medicare drug plans are more than 80% higher
than prices negotiated by the federal government for the Department of Veterans Affairs and 60% higher than prices paid by consumers in Canada.
The report compared the cost of ten well-known brand name drugs through five venues: Medicare Part D, The VA, Canada, drugstore.com and Costco.
The chart below shows the results. Part D is the most expensive despite promises from the administration to keep drug costs down.
Find out if you can get your medicine for free or low-cost at Free Medicine Foundation or the low-cost Generic Medicine Program here.
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According to Mark McClellan, administrator of the Centers for Medicare and Medicaid Services, said drug makers could continue their patient-assistance programs as long as they remain separate from Medicare. However, that would mean those free medications would not count toward a patient's spending total.
For decades, drug makers have offered discounted or free medications to uninsured Americans or people who could not afford critical therapies. In 2004, 37 companies [this figure does not include about 300 more free programs who have donated] donated 22 million prescriptions worth $4.1 billion, said Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, an industry trade group.
Because Medicare Part D sends seniors to private insurers, there are more than 40 plans to choose from, with price ranging from $5 to $70 a month depending on the company, the extent of coverage and the state. To learn which plan is the right one for the individual can be a daunting task, especially when over half of all senior citizens haven’t been on the Internet, and people who called drug or insurance companies often got placed on hold and then disconnected after holding for 15 minutes.
After January 1, when seniors went to pharmacies expecting to be covered, tens of thousands discovered that they weren’t. The insurance companies were late in getting people on the list of those who were covered under new plans. For many seniors and disabled individuals, this meant having to choose between food, paying their rent and purchasing their prescriptions.
As advocates for patients since 1993 needing prescription drugs we suggest:
1.) First, find out if you qualify for free prescription drugs. According to the Wall-Street Journal, it's not just poor people who qualify. Families with annual incomes up to $80,000 can qualify. Click Here To Apply For Free Medicine Online
2.) Find out if your medicines are on a low-cost program. Covered drug prices start at $3.75 for 30 tablets/capsules.
3.) Call 1-573-996-3333 or e-mail: quotes@globalpharmacyprogram.com or fax your medicine list to 1-573-996-5566 for a free quote through the Global Pharmacy Network.
4.) See if you qualify for "EXTRA HELP" with Medicare prescription drug costs. You may be able to get extra help to pay for the premiums, annual deductible, and co-payments related to the new Medicare Prescription Drug Program - an average of $2,100 in extra help.
5.) After applying to find out which medicines you can get for free or low-cost: Consider the cost of your medicines versus the cost of the Medicare Part D prescription drug plan.
Medicare Part D - A tough Pill to Swallow: If you have already enrolled in Medicare Part D and are feeling upset because medications are costing you more than you planned -and you can't afford it- don't despair! You can apply for free medicine and write a letter explaining your situation - we can't guarantee your approval - but hardship circumstances have helped others be approved.
On
occasions, some sponsors will make an exception on a
case-by-case basis or in extreme or extenuating circumstances.
It never hurts to ask. One thing you should know is that there is something more important than income that sways drug companies in letting you qualify for their patient assistance... Hardship! Even if you do not qualify financially, you may still qualify for patient assistance program if you demonstate financial hardship. Some circumstance that might qualify you on the hardship issue include: job turnover, divorce, or other catastrophic events. If you think you would like to
apply, we will be diligent in our efforts to assist you. You really have nothing to lose. We have seen many people who would be considered "middle-class" status enrolled on the hardship basis.
Leading
drug companies have pledged, "No patient in need of medicines
will do without them."
Be sure to share Free Medicine Foundation with your friends and loved ones to ensure that they too are getting the best coverage available for their prescription needs.
Here are some (but not all) questions that you should be asking when considering Part D for you and your family. Our answers are based on the knowledge we have at this time:
How much will Medicare Part D cost?
Not all Part D plans will be equal in terms of benefits and out of pocket expenses.
Even though no money will be collected from you at the time of enrollment, signing up for Medicare Part D coverage is NOT FREE. Regardless of whom you sign up through, a monthly premium will be deducted from your Social Security check. Beneficiaries are expected to pay a monthly premium of about $35 per month, or $420.00 per year. Plus the FULL RETAIL COST of any drugs or new medicines prescribed by your doctor that are NOT covered on the plan you choose.
Despite the Medicare drug coverage that began Jan. 1, there can be significant gaps in coverage depending on which plans seniors choose, so consumer groups say the elderly and disabled could still benefit from drug companies' programs.
Secondly, a $250 deductable must be met before Medicare will begin covering your medication costs. At that point, Part D will cover 75% of drug costs on the "COVERED LIST", up to $2,250. If your costs are between $2,250 and $5,100 ("the donut hole=$2,850"), you will be responsible for 100% of the costs. Finally, 95% of cost will be covered for amounts over $5,100.
It is expected that nearly one half of Medicare beneficiaries will fall into the coverage "gap=$2,850.00" or "donut hole=$2,850.00", and those that do are still required to pay the monthly premium even while they receive no direct benefit.
Are MY Medications Covered?
According to the Medicare law, as few as two medications in each category may be covered. Because not all medications will be covered, the medication you are currently taking may not be covered at all. Each plan will have it's own list of drugs, or a "COVERED LIST", that are approved for use. Medications on the "covered list" may be moved to the 'not covered list' at any time after a beneficiary has enrolled, so coverage for your particular medicine is not guaranteed. Furthermore if your doctor prescribes a different medication, you may have no coverage at all!
Beneficiaries who use several medications will have to research and compare several drug plans to find the one that will cover most of their medications. Regardless of how helpful the plan is to you, you are still responsible for the monthly premium PLUS the full retail cost of the medications that are not covered.
Can I "Wait and See"?
Seniors will have to decide not only whether they need the drug benefit in 2006, but also whether they will need to purchase a plan when they are first eligible, on or prior to May 15th 2006, will be assessed a penalty; the amount of the premium increases by one percent per month for each month an individual delays enrollment. For example, your monthly payment will be 24% higher if you wait two years to sign up. You must assess your health; will it get better or worse as time goes on? Will you require more or less medication? Will you choose to treat your symptoms with alternative methods, such as herbs and exercise? Another question to ponder: Why is a penalty imposed for not signing up before May 15th 2006 for a voluntary program?
What about my employer-provided health coverage?
Millions of retirees with employer-provided health coverage will likely lose their coverage. The Congressional Budget Office projects that 2.7 million retirees will lose the drug coverage they currently receive through former employers who will drop such coverage when the drug benefit becomes availble, even with employer subsidies.
Who might Contact you to sell you on Part D?
Private insurance companies are being paid ongoing fees from the government to gather your personal information and sign you up on the Medicare Part D program. You should be prepared to receive direct mail from them, have them call you at your home, or see ads in the newspaper. They are likely to pursue you agressively since it is in their financial best interest to sign up and enroll as many clients and as soon as possible into Part D.
What Should I Do?
In the months to come there will be a deal of pressure from the private insurance providers to sign up people like you on to one of their Medicare Part D plans. Our recommendation is: do not be in a hurry! Treat this decision as if you were making a major investment, as you could stand to either save or lose thousands of dollars over the coming years. Take the time to obtain the facts. It is very important that you ask questions and look carefully at the details of each plan before you sign up.
There is no question that many seniors will be overwhelmed and confused by the new law. The legislation is so complicated that many presenters themselves will be unable to help you make an informed choice or choose the right plan.
As your trusted "Patient Advocate" we can assist you through the 'Medicare Maze'. Please, do not feel pressured to sign up with the first plan that comes along, as you will be committing yourself to at least one full year with that plan. Before signing up for Medicare Part D, we would advise you to analyze your particular situation and look at all options available.
As advocates for patients since 1993 needing prescription drugs we suggest:
1.) First, find out if you qualify for free prescription drugs. According to the Wall-Street Journal, it's not just poor people who qualify. Families with annual incomes up to $80,000 can qualify. Click Here To Apply For Free Medicine Online
2.) Find out if your medicines are on a low-cost program. Covered drug prices start at $3.75 for 30 tablets/capsules.
3.) Call 1-573-351-1100 or fax your medicine list to 1-573-996-5566 for a free quote through the Global Pharmacy Network.
4.) See if you qualify for "EXTRA HELP" with Medicare prescription drug costs. You may be able to get extra help to pay for the premiums, annual deductible, and co-payments related to the new Medicare Prescription Drug Program - an average of $2,100 in extra help.
5.) After applying to find out which medicines you can get for free or low-cost: Consider the cost of your medicines versus the cost of the Medicare Part D prescription drug plan.
Medicare Part D - A tough Pill to Swallow: If you have already enrolled in Medicare Part D and are feeling upset because medications are costing you more than you planned -and you can't afford it- don't despair! You can apply for free medicine and write a letter explaining your situation - we can't guarantee your approval - but hardship circumstances have helped others be approved.
On
occasions, some sponsors will make an exception on a
case-by-case basis or in extreme or extenuating circumstances.
It never hurts to ask. One thing you should know is that there is something more important than income that sways drug companies in letting you qualify for their patient assistance... Hardship! Even if you do not qualify financially, you may still qualify for patient assistance program if you demonstate financial hardship. Some circumstance that might qualify you on the hardship issue include: job turnover, divorce, or other catastrophic events. If you think you would like to
apply, we will be diligent in our efforts to assist you. You really have nothing to lose. We have seen many people who would be considered "middle-class" status enrolled on the hardship basis.
Leading
drug companies have pledged, "No patient in need of medicines
will do without them."
Be sure to share Free Medicine Foundation with your friends and loved ones to ensure that they too are getting the best coverage available for their prescription needs.
Medicare Part D Creates Windfall Profits for Pharmaceutical Manufacturers
The Medicare law passed in 2003 forbids the federal government from negotiating drug prices with manufacturers, a provision critics said would provide windfall profits for the industry.
"The continued prohibition against such bargaining will not only hurt seniors but will fleece the American taxpayer," says Ron Pollack, executive director of Families USA.
Government: Social Security Administration
NEW MEDICARE DRUG PLANS FAIL TO PROVIDE MEANINGFUL DRUG PRICE DISCOUNTS download FULL REPORT in PDF format. This report comes straight from the United States House of Representatives. Happy Reading!
Free Medicine Foundation Brings Key Players Together as "The Patient's Advocate"
Free Medicine Foundation brings together America’s pharmaceutical companies, doctors, patient advocacy organizations and civic groups to help low-income, uninsured patients get free or nearly free prescription medicines. Its mission is to increase awareness of and enrollment in existing patient assistance programs for those who may be eligible. Through their website, Free Medicine Foundation offers a single point of access to more than 500 public and private patient assistance programs, including more than 150 programs offered by drug makers and other organizations.
PRESCRIPTION DRUGS: America's best-kept secret
is that people
who can't afford their prescription medications can sometimes get
them
free, direct from
pharmaceutical sponsored programs. Applicants can now
apply directly online or
download and print the
initial application in English
or
Spanish
(Uso
español aquí) PDF format. To request a brochure mailed
directly to the patient,
send us an email or call
The Problems with Medicare Part D -- and How to Fix Them
Doughnut Hole Video
This Doughnut Hole video clip is a great visual representation of how the doughnut hole is hurting millions of seniors. Free Medicine Foundation will continue to educate seniors about the doughnut hole and take a stand against it.
The doughnut hole is swindling seniors of their life savings. If you do not have coverage in the doughnut hole once your spending exceeds $2,250, then why would you pay full price across the street when you can pay half price and have your meds delivered right to your doorstep. Or better yet, why not get them for free if it is a hardship for you to pay retail prices for your prescriptions?
If you are one of the 3.4 million seniors that will enter the doughnut hole and start paying the next $2,850 out of your own pocket then let us help you cut this cost by over 80%. If you have any questions regarding the doughnut hole, or if you discover that you are starting to pay full price for your meds once again, give us a call at 1-573-996-3333 and talk to one of our specialty trained staff who will be happy to assist you.
This video clip is part of "The Problems with the Medicare Drug Problem -- and How to Fix Them" hosted by Walter Cronkite and created by FamilesUSA.
Washington, D.C., USA. July 24, 2006 (via www.americansunitedforchange.org)
This video clip is a great visual representation of how the donut hole is hurting millions of seniors. Americans United will continue to educate seniors about the donut hole and take a stand against it. The donut hole is swindling seniors of their life savings and Americans United will not sit by quietly as a generation is financially destroyed.
### Source: Click Here To Watch the Part D Donut Hole Video
