Medicare Part D

Sterling Alam, an Attleboro resident retired from AARP, has read (or, at least, scanned) all 700 pages of the so-called Medicare Modernization Act, the legislation that will bring us the new prescription drug program starting on January 1, 2006. You can be assured that hardly any senators or representatives in Washington can make the same claim.

Alam says he found reading the bill difficult, not merely because of its legalistic language, but because “there were so many things to object to.” For emphasis, he adds: “I think it’s one of the worst bills ever to pass Congress.”

That puts him in the same corner as me. I still seethe at members of Congress for having passed, in late 2003, this politically motivated legislation, favoring vested interests and harmful to American citizens at large. And, typically, the Bush administration has given the new law a euphemistic name─Medicare Modernization Act─ that suggests progress rather than a step backwards.

It also irks me that Congress has failed to accept a single one of the many proposals for improving the program.  

Surely there is something absurdly wrong with a law that, among other provisions, forbids Medicare from bargaining with drug companies for lower prices, even though the Veterans’ Administration has been doing so successfully for years. Also the ban on Americans purchasing prescription drugs from Canada (or any other foreign country) counts in my book as an arbitrary restriction of personal freedom.

I hope that you are not as confused as I am by what you have heard thus far about Medicare Part D (another title for this program). Right now, I do not know what, if anything, to do by way of response to the oncoming plan. Nor does it console me that hardly anyone else seems to understand how to deal with it.

However, in the effort to discover what information is available now, I

tapped into an online Medicare site (www.medicarepartd.org). There I filled out a questionnaire designed to show unnamed officials how to help me.

In response I received an electronic report of several pages adapted to the information I had provided about my own drug situation.

It begins with an announcement of what they call good news and bad news. The allegedly good news is that Medicare will spend 724 billion to assist us with our prescription drug costs; the bad reveals that only four percent of people understand the program “very well.”

From the response, several pages long, I learned some facts about older people who qualify for “extra help.” If you are single and your income is below $14,595 and your resources  $11,500 or less, you will automatically become eligible for Part D. For couples, the figures are $16,862 and $23,000. (Another official Medicare web site gives somewhat different numbers.)

Some other people, however, will be given the subsidy automatically. These include those on Medicare with full Medicaid, those on SSI (Supplemental Security Income), and people covered by the Medicare “Buy In” program. Still, even these groups will have to enroll in a Medicare drug plan if they are to use the subsidy.

Massachusetts residents who are enrolled in the state’s Prescription Advantage program will continue to enjoy the benefits they have now. In addition, the state will provide some help with expenses, such as premiums and co-payments, that are required by Medicare Part D.

Those of us enrolled in Health Maintenance Organizations can reasonably expect to become part of Medicare Part D while continuing to enjoy the drug discounts provided by our membership in the HMO. But, when I called the HMO to which I belong, they could not confirm this or tell me anything more because they are still talking with Medicare authorities.

For information, advice, and counsel about this complicated program, I suggest calling the state-sponsored SHINE program. Counselors can be reached at (800) 243-4636 (AGE INFO). It might also be prudent to save all mail that deals with Medicare matters. You might want to attend some presentations made in an area near you; information about them is available at the phone number noted above.

Many of us already know about the “doughnut hole” which will require individual subscribers to pay prescription drug costs themselves, once they have reached $2250 in total expenses. That requirement lasts until expenses mount to $5100.

The new plan issues drug discount cards, but these will do nothing to discourage increases in costs for individual drugs.

A longtime colleague in the service of older people and their families assures me that the new plan is “frustrating right now for everybody.” This lawyer reports that “all the advocates are dreading the fall season.” And speaking of the intention of the movers behind the prescription drug program, she says with chagrin: “They are privatizing Medicare.”

Another person involved in the field offers simple advice: “Don’t panic.” That seems to me wise counsel, one that I am adopting myself, despite my angry emotions at what is being imposed on us.

Richard Griffin