Wellcare, the outfit I selected (among dozens) to handle my Medicare Part D insurance—that’s prescription drug coverage—just sent me a package to plow through: TWO HUNDRED AND TWENTY-FIVE PAGES of dense, incomprehensible copy to try to figure out!
The booklet you’re supposed to start with, which explains annual changes to the plan, is twelve pages long. Apparently every single year you have to study all this garbage, try to decide if you can live with the changes they’ve come up with, and, if you can’t, try to find another insurance company whose terms you can live with, if any such thing exists.
This year they’re raising the prescription drug coverage from $19.70 to $23.80, or $285.60 a year.
That doesn’t sound like much, except for the fact that you don’t get much for your $285.60 a year. The yearly deductible is $310, so in fact before this thing starts to pay for prescriptions, you pay $595.60 out of pocket. Then it only covers $2,840 until you reach the “doughnut hole.” When your prescriptions have racked up a $2,840 bill (easy to do if you have cancer, diabetes, MS, Parkinson’s, or any of the numerous other ailments of old age), then you’re screwed. You then have to cough up $4,550 for your meds, at which point you reach what Congress in its wisdom has decided is the “Catastrophic Coverage” stage. Then you pay $2.50 for the drugs the company approves, $6.30 for brand-name drugs (many drugs do not come in generic form, you know), or 5 percent of the total cost. Again: Five percent of cancer drugs could add up to one whopping bill.
So really, you’re paying almost $600 for what amounts to only $2,840 worth of coverage. For the cost, it’s very chintzy.
All these plans are about the same: they’re required to provide approximately the same coverage with about the same terms. So, buying a more expensive plan won’t help you, except insofar as some plans apparently are a little more or a little less generous about what types and brands of drugs they’ll cover.
To figure out whether anyone else is offering a comparable drug plan for a lesser price, I’ll have to get a ten- or fifteen-page list from the state SHIP department, plow through that, negotiate telephone punch-a-button mazes to order up information from several insurance companies, and then plow through thirty- to forty-page piles of paper from each of those. Like I have time to do that, and like I could understand what any of that verbiage means, anyway.
Medicare Part D coverage is highly restrictive. To keep you from understanding exactly how restrictive it is, insurance companies have set up a complicated four-tier system involving generic, “preferred generic,” “preferred brand,” and “nonpreferred brand” drugs. It is so baroque as to be incomprehensible. According to the booklet my company sent, some drugs, apparently chosen arbritrarily, can cost you nothing if you order them from WellCare’s pharmacy. Once you start ponying up cash or daring to do business with the nearest drugstore, though, the least you will pay is $36. Yes: per prescription.
Some generics and “preferred brand” drugs can cost you $123 per prescription! Then you get to the Tier 3 “generic and nonpreferred brand drugs,” where you’ll pay $282 per prescription!
Think of that: $282 for a bottle of pills.
To further confuse matters, they move drugs from tier to tier. This year, we’re told, “Some drugs will be in a lower cost-sharing tier; others will be in a higher cost-sharing tier.” So, if you have a chronic disease, chances are you’ll have to change drugs once a year as the companies jack up the cost by moving them up a tier or two.
Evidently they’re supposed to give you some sort of discount on drugs once you tumble into the doughnut hole, but that’s not evident in the 12 pages of daunting gobbledygook in the summary booklet. It says here that the new healthcare legislation, which our Republican friends are campaigning to get rid of, “continues to close the coverage gap, or ‘doughnut hole,’ by reducing the percentage of cost-sharing for beneficiaries in the gap. Effective January 1, 2011, drug manufacturers will provide a 50 percent discount on brand-name drugs and the government will provide a 7 percent discount on generic drugs for those who fall into the coverage gap (Sec. 1101, HR 4872). This is in addition to a $250 rebate, effective in 2010, for beneficiaries who reach the coverage gap.”
All very nice, but it doesn’t change the fact that the doughnut hole amounts to $4,550 and that if you get seriously ill, which all of us will unless we drop dead of a heart attack or are killed instantly in a car wreck, you’re going to be out the cost of your premiums plus the cost of your deductible plus the vast out-of-pocket costs of the doughnut hole. For my modestly priced plan, that would amount to $5,146, not counting the costs of copays ranging from $12 to $235 per prescription.
What we have here is one real good reason why I don’t want to go to the doctor for my bellyache. Don’t know what I’d be getting into…and if it’s anything that requires a lot of drugs, well…
After a month and a half of general misery, I’m pretty sure that whatever is ailing me is probably serious. If it weren’t, it would have passed by now. But with Social Security confiscating an entire month’s benefit—$1,275 gross, $975 net—after my having struggled through a whole summer without enough income to cover my expenses, I’m flat broke. I simply do not have money to pay for doctors and drugs.
What this partnership with despotic private insurance companies actually insures is that seniors will delay going to doctors as long as they can. That actually pushes up costs, because by the time you get to the doctor whatever is ailing you will have reached an advanced stage, which will cost more to treat.
Some puppies are pleased that we lazy, greedy old bustards who oughta get a job won’t see a cost of living increase from Social Security in 2011, for the second year in a row. WellCare’s premium is the smallest part of my Medicare bill. If it’s gone up $4, you can be sure the much more expensive Medigap policy will go up even more. I’m already ponying up $90 a month (God only knows what it’ll be in 2011) to another private plan to cover the many lacunae in the government plans (Part A and Part B), and Part B itself, costs $111 a month for rather skimpy coverage.
With Part D, you have the option of taking a chance that you won’t get sick and won’t need a lot of drugs before you croak over. There’s no law that says you have to buy Part D coverage. (If you think the game doesn’t play out in favor of the table at Vegas, then by all means take this bet!) But if you don’t get it at the first opportunity when it’s offered to you, then the cost goes way, way up: effectively, you’re punished for not buying insurance from private corporations until you think you’re actually likely to need it.
Nor is there any law that says you have to buy Part B. But you’d be a fool if you didn’t, unless you’re already so poor as to qualify for Medicaid. Part A is roughly the equivalent of major medical. It doesn’t cover much.
So far it appears the Medigap coverage works pretty well, though I haven’t used it except for the useless follow-up care for the torn rotor cuff, which I can’t afford to have repaired because I can’t afford to take a semester off my part-time job. So to date, I’ve paid $90 a month for air. Presumably next year the cost of air will even higher.
For $111 a month plus all the Medicare taxes I’ve paid and still pay on every dime I scrape together, Medicare should cover everything—without forcing beneficiaries to open their wallets wide to the rapacious insurance industry.
I keep hoping we’ll have a single payer system by the time I retire–doubt it though.
Here in South Dakota (yes people ACTUALLY live here!) you can get help through the Cooperative Extension service in selecting your Medicare part D coverage. You might call your local county extension office (if the state hasn’t closed them all) and see if you can talk to an Extension Specialist. Hopefully they can help you select which is best for you. 225 pages – yea reading that is how people want to spend their “retirement!”. Good luck FAM!
A healthcare system that won’t help you when you’re young or old… dear God. Some Americans may call the healthcare system here in the UK Communist or worse, but at least you get treated.
@ Lynda: A healthcare system that throws you to the wolves of the insurance industry is not a system. It’s chaos.
@ sandra jensen: Are they actually employees who are experts in navigating the bureaucracy? Here our SHIP office is staffed by volunteers. Some of them sort of know what they’re talking about and some haven’t a clue. The last time I called over there I got a nincompoop who, in response to one specific question, insisted on reading the entire canned speech from beginning to end, in spite of my saying, three times, that I had already spoken to someone who told me all that and that I had one, simple, specific question. It took 15 minutes to listen to the arrogant idiot, and at the end I still didn’t have an answer.
@ frugal scholar: As long as we have doctrinaire politicians and demagogues in office, we will never have a single-payer system.
You have the absolute worst case of “Bag Lady Syndrome” I’ve ever heard of. You’ve had a stomach ache for a month and a half and you don’t want to go to the doctor because you think it’s probably serious and you don’t want to dip into your savings? That may just be one of the dumbest $%^ing things I’ve ever heard.
I’ve been following your blog for long enough that I feel like I know you. It’s too bad I don’t because I’d drag your a$$ to the doctor’s office myself!
GO TO THE DOCTOR!!
@ Pat: Yes, I certainly do suffer from Bag Lady Syndrome. The perception that I have about $70 to live on between now and October 5 contributes to that.
But more to the point, I truly distrust doctors. Even the best have tried to foist various kinds of unnecessary treatments on me, have prescribed drugs that were contraindicated and had negative side effects, and have made dangerously incorrect diagnoses.
The way my mother was treated on her deathbed was horrifying. As she lay dying of cancer, her doctors, in whose financial interest it was to deny she was ill, told my father she was a mental case and needed a psychiatrist; they told him that if she was as anorexic as he claimed (every bite she put into her mouth bounced right back out) she would have starved, and so she must be sneaking out of bed at night and raiding the refrigerator — as though he were such a moron he couldn’t tell whether the food was disappearing out of the icebox. One of them told me to my face that she was “a crock.” Once she was opened up and found to be full of tumors, they turned their back on us — one of them did so literally, refusing to speak to us when we tried to find out what to expect or what could be done.
She would have died anyway, but she suffered hideously because, trapped in an HMO, my parents couldn’t get competent medical care for her. All she needed was a competent diagnosis and palliative care, but that was denied because decent care of a catastrophic illness would have cost the HMO too much –it basically hired its doctors as shareholders, so that their pay depended to a large extent on how much they could save the insurance company. Ultimately to get the most basic kind of care — I mean, just keep her clean! — I had to threaten to file a law suit. Only after I uttered the words “and my next call will be to my lawyer” did her doctor show up on the day we found her laying in a pool of fluids leaking from her incision.
During that time, I learned from a medical doctor that most doctors believe women over the age of 45 are neurotic by definition. When you go in with some vague ailment like a bellyache, you are assumed to be suffering from “stress” or simply to be a hypochondriac. In those circumstances, visits to doctors can devolve into an exercise whose value ranges from nil to worse than nil.
I have had a doctor tell me that I was incapable of handling the ordinary stresses of daily life, when what I had was early signs of appendicitis. I have had a gynecologist tell me and one of my best friends that we each needed unnecessary surgery — when I went to another gynecologist I was told the would-be surgeon had a reputation among his colleagues as “the butcher of Phoenix.” I still have a large scar on my breast where a dermatologist removed a mole, without gloves and wearing her rings, and then failed to close the incision properly.
To diagnose a hiatal hernia or celiac disease, what they want to do is stuff a tube down your throat — in the case of celiac disease all the way down into your intestines. I don’t wanna do that. I would rather wait and see if the condition resolves on its own before I put myself through an invasive procedure. In the past with bellyaches, I’ve found that by the time a doctor would see me, the problem has passed.
Is money an issue? Yes, it sure is. We’re coming up on November, and I still have not recovered financially from trying to get through the three summer months with less income than outgo. I’ve had to eat into my catastrophic emergency fund — money set aside to support me should anything happen that I can’t work at all. Though I’ve managed to replenish the fund by pinching every penny I can pinch, I now have exactly $70 to spare between now and the time my next paycheck comes in. Next month’s Social Security check will be $110 short, because they’re not done punishing me for earning $340 too much this year. And in December I will not earn a full month’s pay. So yes, you bet money is an issue. I really don’t want to spend my retirement savings, which I need to refrain from dipping into for another five years, on what may be unnecessary doctoring.