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<< Previous   of   Next >>   ADVERTISEMENT   Related Stories • How to make the most of snow 1/29/08   CONTACT THE HERALD Melanie Munk, Features Editor munk@heraldnet.com   Published: Tuesday, January 29, 2008 Medicare drug plan just a big headache By Linda Bryant Smith Herald Columnist I am snowbound, winter weary and getting darn cranky. When we do venture out on icy roads between snow flurries, the parking lots are an ice-rink-o-rama. Our neighbor Norm is down with a cracked rib. Another friend called to report that three friends have taken serious spills: one broken leg, one sprained wrist, one sprained ankle and multiple bruises. It's too cold for my husband too venture out to his Man Room, we're fresh out of unread books, and the current television offerings are grim and grimmer, or is that dumb and dumber? So when the mail brought yet another five-page report from Medicare on how much I saved last year by subscribing to Part D, the prescription drug program, my mood became even darker. Talk about dumb and dumber. Five pages of propaganda about the wonders of the system when, in reality, I saved zip, nada, nothing because I wasn't sick enough to require expensive medicine. I take three maintenance drugs. One for a thyroid that does not function well on it's own and a couple to keep my blood pressure at ideal levels. I buy the generic versions of these drugs. Last year that meant a $6 co-pay for each if I used my insurance and bought them at my local pharmacy by the month. Slightly less for a three-month supply. For this, I paid a $25 monthly premium for the AARP Medicare Rx Preferred plan. This year the premium went up to $33. but, if order a 90-day supply from AARP's preferred mail-order prescription drug service, I can have my generic drugs without cost. No fee for shipping, either. However, I was short on one and could not wait for the reorder process, so I went to my friendly Safeway pharmacist to buy a month's supply. She handed me the bill for $14.79 and asked sweetly if I wanted to use my insurance plan. "No," I said. "Don't use my Part D insurance you have on file, just give me the Wal-Mart price." She went back to her computer and returned with the bill. "That will be $4." So, without insurance my three generic drugs will cost $12 a month at my local pharmacy. With insurance, the same drugs are "free" with my $33 monthly premium. Moreover, when I buy drugs using the Part D plan, the amount Medicare records, as the actual cost is that $14.79 or whatever the higher retail price may be. And that's the amount charged against my "initial coverage allowance." Why does this matter? Because if I had a serious illness that required extensive medications, it wouldn't take long to reach the infamous doughnut hole. This year the magic number is $2,510. Once Medicare records show a person has reached that total for prescription drugs, the individual must pay 100 percent of prescription drug costs until the total hits $4,050 and then coverage kicks in again. An insurance agent for a Medicare Advantage plan told me she advises her clients to subscribe to Plan D, but buy their generics without using the insurance. Thus they keep their Medicare initial coverage allowance intact for a serious health crisis when every penny counts. Neighbor Norm of the broken rib does this. He would have hit the doughnut hole in late November and paid hundreds of dollars for prescription drugs in December had he not purchased his generic drugs outside the insurance system earlier in the year. So many reasons to be cranky. Why is a generic drug that anyone can buy for $4 a month, priced for Medicare purposes at $14.79? Why can you go to Mexico and Canada and purchase a 90-days supply of that same generic drug for less than $6? What happens if I just drop Plan D and buy generics at $12 a month? Ahh. Therein lies the same danger as strolling across the ice-o-rama outside my door. First, it's January and I can't just "un-enroll" until the open enrollment period next Nov. 15, a customer service representative for my plan told me. If I did opt out during an open enrollment period, I could not enroll again until the next such period. And, then a penalty would be added to my new premium. That would be, she said, at least 1 percent for each month I was without Plan D. So, if I opted out next November it would be effective Jan. 1, 2009, and then it would be another full year before I could get coverage again at an even higher premium. Take a risk, make a bad choice, pay the price. Short of a bankrupt Medicare system, I don't foresee any changes in this system that's greatest claim to success must be the mountains of paperwork it generates. We could, of course, ask for federal legislation forcing members of Congress and the executive branch of our government to have Medicare as their primary health insurance. Like that would ever happen, no matter how much the presidential candidates prattle on about the need for "change" in government. And that's a good enough reason to make anyone cranky. Linda Bryant Smith writes about life as a senior citizen. You can e-mail her at ljbryantsmith@yahoo.com.

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