Funny about Money

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.