Screwy new GOP Medicare plan

Expect to see a bunch more stories like this about the “drug plan” they passed.

After five years of getting her prescriptions filled for no charge at her local pharmacy in Maple Valley, Estella Easterly, 84, says she recently was told she had to pay full price — or go without.
She couldn’t prove that she had enrolled in one of Medicare’s new Part D drug plans. Her insurance company hadn’t sent her a membership card yet, and it set up her eligibility information improperly in the computer system. So Easterly — who lives on about $600 a month — paid what she could: $24 for a half-month’s worth of one of her medications.
“I’m not one that cries very easily,” said Easterly, a widow who used to get her drugs paid for by the government because of her low income. “If I can’t get it straightened out, I’ll just have to do without my medicines. I just can’t afford that every month.”
Easterly’s frustration has become common as tens of thousands of Washington residents — especially the poorest of seniors and the disabled — have encountered a rough transition to the government’s new prescription-drug plans.

Novak blames it on Rove.

Medicare Plan D is a disaster for those who need it most. There are very ill people who will enter that “doughnut hole” and have to pay out the nose for their life-saving medications. I hear that this is especially bad in Florida.

We are past the Jan 1st deadline, and there is still a huge amount of confusion and misinformation. A large proportion of patients, caregivers, doctors and staff (sigh) are still confused.

Some myths: (New york state)

  1. You must enroll in a medicare plan to receive medicine. Many patients have enrolled in medicare HMOs (they call them medicare advantage plans) that include drug coverage. Traditional disadvantages include having to get a referral, picking a PCP, and drug formulary restrictions.

It’s frustrating to tell a patient that they cannot be seen because the doctor is not in that HMO plan. It’s more frustrating to spend the time patiently explaining their choices, which one fits them better, and then have them lash out in frustration and say I’m being mean and stupid.

  1. Many people (50% even?) are still not aware they were automatically enrolled in a part D program. The upside is you can go to Medicare.gov, punch in the information, and it tells you what plan they are enrolled in (sometimes it fails as the central database has inaccuracies such as mispelled names and the wrong date of birth.) The nice bit is you get the online formulary. Disadvantage: you have to do it for each individual patient, and there doesn’t seem to be a handy way to get generic information for each drug plan. Drug plans also reserve the right to change the formulary at any time (i think they need to give 2 months notice).

The upside of the plan: Medicaid doesn’t have to spend so much money. A huge expense is passed from state governments to federal governments. As much as people like to complain about federal governments, I’ve found NY state governments to be disgruntled, unhelpful, inefficient. They use archaic systems with proprieatory software (submit claims via TAPE?). Their ‘manuals’ are outdated and confusing. I really prefer IRS forms. At least the IRS has a search function that works, and you can download all the PDFs and read them at your leisure.

/rant off