Medicare Part D

Medicare Part D - 10/23/08

INTRO: When Golden Opportunities began 10 years ago, there was no drug benefit under Medicare. People who couldn't afford the skyrocketing costs of their drugs had to choose between food and medicine. Others chose to cut their pills in half, or just to skip their medications altogether, risking their health and their lives. Finally Congress stepped in and passed Medicare Part D. Has it worked?

1. WHAT IS MEDICARE PART D?

A. Beginning in 2006, Medicare started offering prescription drug coverage through private companies.

Each private drug plan is different. Benefits, drugs covered, and costs vary. But at a minimum, a basic plan must meet these rules:

  • You pay the first $275 for covered drugs.
  • For costs between $276 and $2510, you pay 25%, medicare pays 75%.
  • Between $2511 and $5726.25,you pay all costs (that's the doughnut hole).
  • for catastrophic costs above $5726.25, you pay only 5%, Medicare pays the rest.

So this year, you must pay $4050 yourself before you reach this final level of catastrophic coverage.

I should also note that if you have limited income, there is extra help available from Medicare.

2. HOW'S THE PROGRAM TODAY?

A. The program is still confusing, and the government still hasn't done enough to educate people. With dozens of different private plans, offering different coverages, and different costs, it's very hard to be a good consumer and pick the best for you.

A second problem is that your needed drugs may not be covered. Each plan covers different drugs. You have to sort through and pick the plan that covers most or all of your most expensive medications.

A third problem is the red tape. People still have trouble getting their medications because they have not obtained prior authorization from the plan, or because the prescription exceeded the plan's pill quality limits, or because the patient had not first tried to use less expensive drugs.

3. WHEN WE SIGN UP, WE SHOULD PICK A PLAN THAT COVERS OUR MOST NEEDED DRUGS. WHAT IF OUR HEALTH NEEDS CHANGE AND WE NEED DIFFERENT DRUGS?

A. You can only change plans once a year. So you may end up paying for a plan that doesn't cover your needs.

4. HAS PART D HELPED KEEP OUR DRUG COSTS DOWN?

A. No. Just the opposite. Medicare Part D has actually led to higher drug costs.

The government failed to take two important steps to keep costs down when the plan was adopted.

When Congress created the Part D program, it could have very easily created competition, which would have kept prices down. For example, Congress could have allowed people to buy their medications from Canadian pharmacies. Prices for drugs from Canada are often half the price of the same medications sold in the U.S. And the federal government could have used its huge market power to negotiate lower prices with the mammoth drug companies participating in America's medicare and Medicaid programs. But Congress failed to create those safeguards for consumers. In fact, Congress explicitly prohibited government agencies from negotiating lower costs.

More recently, Congress did change the law to allow Americans to buy their medicines from Canada. But there's a huge limit: Americans may personally go to Canada and bring back medicines with them. But we cannot buy Canadian drugs by mail or over the Internet. This is the part I don't understand. The reason Americans were given for the ban on importation was that our government could not assure that imported drugs are safe and not counterfeit.

But if the U.S. government is now allowing Americans to bring back medicines from Canada, they must have decided the medicines are safe. If that's the case, why continue the ban on imports by mail or over the Internet.

CLOSE: What do you think? Has Medicare's prescription drug program been a success? And is it helping you?