eyesopened
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ORIGINAL: cadenas
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ORIGINAL: willbeurdaddy
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ORIGINAL: eyesopened
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ORIGINAL: cadenas
I would consider Medicare high-quality health care. At least no Medicare recipient has to worry about recission in the middle of a Cancer treatment. The only area where Medicare is really inferior is where private insurances are allowed to meddle: Part D.
I'm curious. How is Part D inferior? As I recall, Medicare didn't cover prescriptions drugs prior to Part D. I understand that Part D is administered by private insurance, but most Part D plans have little or no premiums and recipients pay co-pays just like anyone else with prescription insurance. How is this inferior to having no prescription insurance at all?
Medicare Part D has been extremely successful and the only government health program to ever come in at lower that projected costs.
Because the cost was offloaded onto the Medicare recipients.
Ever heard of the doughnut hole?
Or tried to navigate through all the gazillion plans when you take five or six prescriptions, and none of the plans covers all of them?
Or picked a plan that covers your diabetes meds, and six months later when you are diagnosed with cancer you suddenly find out that the chemotherapy drugs aren't on that plan's formulary?
First of all, prior to Medicare Part D, Medicare recipients had NO presecription insurance at all. They paid full retail for all medications.
The "donut hole" doesn't exist for anyone dully eligible (Medicare + Medicaid) nor to anyone who earns 150% of Federal Povery Guideline or less, even if they aren't eligible for Medicaid. http://www.cms.hhs.gov/States/03_lowincomesubsidy.asp The coverage gap is filled by many insurance plans if one is willing to pay a premium. Each Part D insurer offers more than one plan for Part D.
Chemotherapy is a Part B (medical) drug and is covered under Original Medicare Part B. Part D hasn't changed that.
Every plan must have an instrument to cover "non-formulary" drugs or face penalties by the government.
http://jop.ascopubs.org/cgi/content/full/2/3/108
Each plan is required by law to cover at least 2 drugs in every category. I have been invovled with the administration of Part D services since 2004 so please don't tell me the cost was passed onto Medicare recipients.
In the first phase of MMA, Medicare recipients below FPG were also given $600 credit toward their medications, gratis. I called hundreds of eligible people who had no idea this credit was available. One woman had a medication that a 30-day supply cost nearly as much as she was getting in SS. She was turned down by Medicaid because she had insurance assets. She was buying a pill at a time as she could afford it. When I told her about the $600, she started crying and told me I was an angel from God because she was sick and knew she needed her meds but had no money. Please do NOT tell me Part D cost this woman anything. It probably saved her life.
The insurance companies have added benefits and lowered premiums in an efffort to compete with each other. In an effort to provide more benefits, most insurers offer a combined plan that acts as a supplimental insurance but with additional benefits like vision, hearing, and dental, plus coverage for presciptions during the "gap".
Every state has agencies who will review plans with eligible people during the enrollment periond. Medicare(dot)gov allows a person to list all their medications and get side-by-side plan comparisions.
All of a sudden, after Part D, retailers started competing with each other to offer $5 prescriptions, it has been wonderful to see how humane retailers became after Part D.
Editied to add links
< Message edited by eyesopened -- 12/5/2009 5:10:53 AM >
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