Parkinson's Disease Tulip


advertisement
Reply
 
Thread Tools Display Modes
Old 10-30-2006, 09:18 PM #1
Stitcher's Avatar
Stitcher Stitcher is offline
Magnate
 
Join Date: Aug 2006
Posts: 2,136
10 yr Member
Stitcher Stitcher is offline
Magnate
Stitcher's Avatar
 
Join Date: Aug 2006
Posts: 2,136
My Mood: 2007 Medicare Part D Open Enrollment
10 yr Member
Default 2007 Medicare Part D Open Enrollment

It is that time. Open enrollment for 2007 begins soon.

************************************************** ******

Medicare Website
www.medicare.gov1-800-MEDICARE • TTY 1-877-486-2048

Online Pamphlet
http://www.medicare.gov/publications.../11220_alt.pdf

October – Compare and Prepare
  • Watch your mail for the Medicare & You handbook and for information from plans in your area.Complete the Rx Enrollment Check-up.
  • In mid-October, review and compare plans on cost and coverage at www.medicare.gov on the web.
  • Decide what plan you want for 2007. If you’re satisfied with your current plan, there is no need to re-enroll.

November 15 – Open Enrollment Begins
First day you can change your Medicare health or prescription drug coverage for 2007.
Open Enrollment is the one chance this year
most people with Medicare have to make a change in their health and prescription drug plans.

December 8 – Don’t Be Late
If you are going to make a change to your current coverage,
enrolling by December 8 helps to ensure that you can get the prescriptions you need on January 1.

December 31 – Open Enrollment Ends
Medicare’s Open Enrollment ends on December 31.
The next Open Enrollment period will begin on November 15, 2007.

January 1 – 2007 Coverage Begins


************************************************** ******

Medicare Prescription Plan Finder

http://tinyurl.com/yh2o7t
Search includes personalized information about:

* Medicare Prescription Drug Plans
* Medicare Health Plans (that cover drugs)

Supporting Information
http://www.medicare.gov/MPDPF/Shared...nguage=English

Amount the many questions answered:
Can I decide not to join?
  • Joining is your choice.
  • However, if you don’t join when you are first eligible, you may have to pay a penalty if you choose to join later.
  • Like other insurance, you will have to pay this penalty as long as you have Medicare prescription drug coverage
__________________
You're alive. Do something. The directive in life, the moral imperative was so uncomplicated. It could be expressed in single words, not complete sentences. It sounded like this: Look. Listen. Choose. Act. ~~Barbara Hall

I long to accomplish a great and noble tasks, but it is my chief duty to accomplish humble tasks as though they were great and noble. The world is moved along, not only by the mighty shoves of its heroes, but also by the aggregate of the tiny pushes of each honest worker. ~~Helen Keller
Stitcher is offline   Reply With QuoteReply With Quote

advertisement
Old 11-02-2006, 11:33 PM #2
Stitcher's Avatar
Stitcher Stitcher is offline
Magnate
 
Join Date: Aug 2006
Posts: 2,136
10 yr Member
Stitcher Stitcher is offline
Magnate
Stitcher's Avatar
 
Join Date: Aug 2006
Posts: 2,136
My Mood: 2007 Medicare Part D Open Enrollment
10 yr Member
Default

Group Says Gap in Medicare Drug Coverage Will Be Costly

By Christopher Lee
Washington Post Staff Writer
Thursday, November 2, 2006; A11

http://www.washingtonpost.com/wp-dyn...103324_pf.html

Medicare beneficiaries will have to pay substantially more next year for coverage of brand-name prescription drugs that keeps them from falling into the "doughnut hole," according to a new report that government officials swiftly criticized as incomplete.

The report, released yesterday by the advocacy group Families USA, found that average monthly premiums will rise 87 percent, to $103.20, for plans that provide "meaningful coverage" in what otherwise would be a gap in Medicare's prescription drug benefit. Such coverage also will be harder to find -- 13 states will have no plans offering it in 2007, up from four states this year, the report found.

A plan was considered to have "meaningful" coverage if it paid for the top 25 drugs prescribed to seniors, including Lipitor, Prevacid, Zocor and Zoloft, group officials said. Eighteen of the drugs are not available in generic form.

"This coverage gap never made sense for seniors, but now it is getting much worse," said Ron Pollack, executive director of Families USA, who has repeatedly criticized the design of the drug benefit.

The "doughnut hole" refers to a gap in coverage in which Medicare beneficiaries must pay for 100 percent of their drug purchases. About 3 million people are expected to fall into it this year, according to the Centers for Medicare and Medicaid Services. Democrats have criticized the gap as unfair to seniors, but party leaders say they will not be able to get rid of it right away even if they regain control of the House in next week's elections.

Under the standard plan, Medicare picks up most of a beneficiary's drug costs up to $2,250. The coverage then stops until the beneficiary has spent an additional $2,850 out of pocket, after which Medicare covers 95 percent of additional drug costs. Beneficiaries may select plans that do not have a gap, but the premiums are higher than those of standard plans. Low-income beneficiaries get subsidized coverage with no gap.

Leslie V. Norwalk, acting head of the Medicare agency, said the Families USA report "presents a distorted and incomplete picture" because it ignores plans that fill the gap with coverage for generic drugs. Beneficiaries in every state can choose a plan that provides some or complete gap coverage, she said, and they will have even more choices next year.

"The report focuses on a very limited number of drugs used by beneficiaries and does not acknowledge the significant additional savings possible through the use of lower-cost generics and therapeutic substitutes," Norwalk said.

House Minority Leader Nancy Pelosi (D-Calif.) has said Democrats would require Medicare to negotiate with drug companies for lower prices and use the savings to shrink the doughnut hole. "We can and we must make the Medicare prescription drug plan fairer and more cost-effective," she said.

But Norwalk told Bloomberg News yesterday that having Medicare negotiate drug prices with manufacturers would not achieve savings over the current system, in which insurers and pharmacy benefit managers do the negotiating to offer competitive plans.

The national average monthly premium for all plans with any doughnut-hole coverage, including generics-only coverage, will drop from $48.40 this year to $47.40 in 2007, Families USA officials said. But a plan will not help most seniors unless it provides coverage for the brand-name drugs they take, Pollack said.

Sen. Charles E. Grassley (R-Iowa), chairman of the Senate Finance Committee, said erasing the gap would cost more than $400 billion over 10 years: "The Medicare prescription drug program may not be perfect, but beneficiaries now can get affordable prescription drug coverage, and they can choose a plan, including a plan with gap coverage, that best meets their needs."
__________________
You're alive. Do something. The directive in life, the moral imperative was so uncomplicated. It could be expressed in single words, not complete sentences. It sounded like this: Look. Listen. Choose. Act. ~~Barbara Hall

I long to accomplish a great and noble tasks, but it is my chief duty to accomplish humble tasks as though they were great and noble. The world is moved along, not only by the mighty shoves of its heroes, but also by the aggregate of the tiny pushes of each honest worker. ~~Helen Keller
Stitcher is offline   Reply With QuoteReply With Quote
Old 11-08-2006, 12:19 AM #3
Stitcher's Avatar
Stitcher Stitcher is offline
Magnate
 
Join Date: Aug 2006
Posts: 2,136
10 yr Member
Stitcher Stitcher is offline
Magnate
Stitcher's Avatar
 
Join Date: Aug 2006
Posts: 2,136
My Mood: 2007 Medicare Part D Open Enrollment
10 yr Member
Default

As Drug Prices Climb, Democrats Find Fault With Medicare Plan

The New York Times
November 6, 2006
By ALEX BERENSON

http://www.nytimes.com/2006/11/06/bu...cy&oref=slogin

For big drug companies, the new Medicare prescription benefit is proving to be a financial windfall larger than even the most optimistic Wall Street analysts had predicted.

But those gains may come back to haunt drug makers if Democrats take control of Congress this week.

Democrats, who have long charged that the drug industry is profiteering at taxpayers’ expense, say they want to introduce legislation to revoke the law that bars Medicare from negotiating prices directly with drug makers like Pfizer for the medicines it buys.

Medicare now pays for drugs indirectly, through the private insurers that administer the prescription program — and those insurers typically pay higher prices than government agencies, like the Veterans Administration, that buy medicines directly from drug makers.

The government is expected to spend at least $31 billion this year on the drug benefit, which provides partial drug coverage for people over age 65 [and the disabled], according to the federal agency that runs Medicare. Next year, the program is expected to cost almost $50 billion — almost 20 percent of overall American drug spending.

Democrats say that directly negotiating with drug makers could save taxpayers tens of billions of dollars annually, though some independent analysts say those projections are probably exaggerated.

Republicans, and the pharmaceutical industry, say that the benefit program is working and has cost less than initially projected. More than 38 million Medicare beneficiaries are enrolled in the program, and most say they are satisfied with their coverage, said Michael O. Leavitt, the secretary of health and human services.

“It’s very clearly working,” Mr. Leavitt said. “We now have 90 percent of seniors in this country who have prescription drug coverage.”

But Wall Street analysts say they have little doubt that the benefit program, called Part D, has helped several big drug makers report record profits and exceed earnings forecasts made earlier in the year.

Companies have raised prices on many top-selling medicines by 6 percent or more this year, double the overall inflation rate. In some cases, drug makers have received price increases of as much as 20 percent for medicines that the government was already buying for people covered under the Medicaid program for the indigent. Medicare also pays more than the Veterans Administration, which runs its own benefit program.

“Part D was a good thing for almost everybody,” said Les Funtleyder, an industry analyst at Miller Tabak, a research firm in New York.

Drug makers have tried to play down their gains from the program because they do not want to be seen as profiteering in an election year, Mr. Funtleyder said. “You don’t want to draw too much attention to how good it’s been.”

Democrats claim the government could save as much as $190 billion over the next 10 years if it negotiated directly. Those savings could help shrink the “doughnut hole,” the gap in Part D coverage that forces many beneficiaries to pay about $3,000 a year for drugs, said Brendan Daly, a spokesman for Nancy Pelosi, the Democratic leader in the House.

“What we’re planning to do is give Medicare a chance to negotiate prices, and we’d use some of the savings to close the doughnut hole,” Mr. Daly said.

Republicans say the savings estimates offered by the Democrats are vastly inflated. They note that Medicare has already cut its 10-year projection of the program’s cost by $117 billion, though the program is still expected to cost taxpayers $516 billion over the next decade. Republicans also note that, in independent surveys, most seniors say they are happy with the benefit.

“The competitive marketplace has saved much more money than anyone has ever anticipated,” said Leslie Norwalk, the deputy commissioner of the Centers for Medicare and Medicaid Services.

Ken Johnson, senior vice president at Pharmaceutical Research and Manufacturers of America, the main lobbying group for drug makers, said that allowing Medicare to negotiate directly would be unfair because the government had too much market power.

“The government doesn’t negotiate prices — it dictates prices,” Mr. Johnson said.


Also, the Veterans Administration and Medicare plans are not directly comparable, he said, because the average Medicare drug plan covers 4,300 medicines, while the V.A. covers only 1,300.

The structure of Part D is complex. Medicare does not directly provide coverage. Instead it subsidizes plans offered by private insurers. Insurers negotiate prices with drug makers and create menus of different plans, some with high premiums and broad drug coverage and others that offer basic coverage at low premiums. All plans have to follow certain basic rules, like offering at least two medicines in every drug category.

Medicare then calculates the cost of the average plan and pays every insurer a subsidy of about 75 percent of that cost. Beneficiaries cover the rest, with the amount they pay depending on what plan they choose.

For example, if the average plan costs $100 a month, Medicare will pay all plans a $75 subsidy for everyone who enrolls, and a person who enrolls in the average plan will pay $25 [this "average plan" would be one that does not cover the "gap"]. In most states, beneficiaries can choose from among 40 to 60 plans, Ms. Norwalk said.

Part D has raised profits for drug makers both by increasing the prices they receive and by encouraging beneficiaries to fill prescriptions they might otherwise have been unable to afford, analysts say.

The biggest gains have gone to companies that make drugs widely used by the Medicaid program, which covers the indigent. Poor people over 65, known as “dual eligibles,” previously received drugs through Medicaid.

Drug makers were legally required to give Medicaid a discount of at least 15 percent, and sometimes significantly more, from their list prices. Now Medicaid recipients over 65 are covered through the Part D program, which does not require the same discounts. As a result, drug makers are being paid as much as 20 percent more for the same drugs that they had already been providing to recipients under the Medicaid program.

The biggest gainer, analysts say, is Eli Lilly, which makes Zyprexa. Zyprexa, used to treat schizophrenia and other severe mental illnesses, is widely prescribed to Medicaid patients.

Lilly, the sixth-largest American drug maker, reported two weeks ago that its third-quarter sales had risen 7 percent, to $3.9 billion, and its profits were up 10 percent, to $874 million, compared with 2005. According to Lilly’s published review of the quarter, the sales gains resulted almost entirely from Lilly’s prices rising 11 percent in the United States, while actually falling in Europe and Japan.

“We are experiencing a one-time sales benefit resulting from a shift of certain low-income patients from Medicaid to Medicare,” a company spokeswoman, Terra Fox, wrote in an e-mail response to questions about Part D. Ms. Fox declined to quantify how much Lilly had gained from the shift.

But Lilly is hardly alone in benefiting. Pfizer, the world’s largest drug maker, said its sales soared 14 percent in the United States in the third quarter, while rising only 3 percent internationally. Over all, Pfizer said its profits more than doubled, to $3.4 billion from $1.6 billion, though part of the difference came from high one-time charges last year.

Pfizer did not disclose how much of the sales growth came from price increases and how much from new prescriptions, but earlier this year Pfizer raised the list prices of some of its biggest drugs by 5.5 percent or more, well above the inflation rate.

Tony Butler, an analyst at Lehman Brothers, said both volume growth and price increases had driven the industry’s rising profits. But he said he did not expect major changes in the Part D plan even if the Democrats took over Congress, since President Bush would probably not sign any legislation that would allow Medicare to negotiate prices directly.

“It’s our belief that the White House will veto it,” he said.
__________________
You're alive. Do something. The directive in life, the moral imperative was so uncomplicated. It could be expressed in single words, not complete sentences. It sounded like this: Look. Listen. Choose. Act. ~~Barbara Hall

I long to accomplish a great and noble tasks, but it is my chief duty to accomplish humble tasks as though they were great and noble. The world is moved along, not only by the mighty shoves of its heroes, but also by the aggregate of the tiny pushes of each honest worker. ~~Helen Keller
Stitcher is offline   Reply With QuoteReply With Quote
Old 11-08-2006, 12:30 AM #4
Stitcher's Avatar
Stitcher Stitcher is offline
Magnate
 
Join Date: Aug 2006
Posts: 2,136
10 yr Member
Stitcher Stitcher is offline
Magnate
Stitcher's Avatar
 
Join Date: Aug 2006
Posts: 2,136
My Mood: 2007 Medicare Part D Open Enrollment
10 yr Member
Default Don't Assume Your Current Plan Continues As Is In 2007

Time to Take Another Look at Medicare Drug Plans

The New York Times
November 7, 2006
Personal Health
By JANE E. BRODY

http://www.nytimes.com/2006/11/07/he...tml?ref=policy

Maybe you already signed up for Medicare Part D, the prescription drug benefit plan, and maybe you didn’t. Either way, experts strongly urge that every Medicare recipient take a second look.

Those already in a plan may want to consider changing plans during the next sign-up period, Nov. 15 through Dec. 31. Those who are still on the fence about whether to join a plan may want to enroll now, before the penalties for delayed enrollment increase significantly.

Though legislation is pending in Congress to drop the premium penalties, at least for this first year, they are still in place and amount to 1 percent of the average national monthly premium for each month that you didn’t sign up.

If you haven’t yet signed up and do so in November, you will pay a premium penalty of 7 percent — 1 percent for each month since May. If you wait a year, the premium penalty will be 19 percent, and the average national premium may be higher as well. Furthermore, these penalties are not a one-time matter; they will stay with you as a higher monthly premium for as long as you are in a Part D plan.

People who currently have drug benefits through other insurance plans should not join a Part D plan unless it is much better than their current coverage.

They will not be penalized for joining a Part D plan at a later date unless they lose their current benefit and fail to sign up for a Medicare plan at the next opportunity. Deane Beebe of the Medicare Rights Center, a nonprofit advocacy group in New York, pointed out that people with drug benefits through a non-Medicare plan risked forfeiting their current coverage if they signed up for a Part D plan.

Some Problems

There are two main problems with Part D:

1) There are far too many choices. California, for example, has 55 stand-alone prescription drug plans, not counting dozens more in individual counties. Each plan has its own premium, its own formulary for the drugs it covers, its own deductible and its own copayments for individual drugs. Anyone taking half a dozen prescription drugs may need higher math to figure out which plan would provide the most benefits. During this next sign-up period, the Medicare Rights Center will provide free access to its plan finder, at www.medicarerights.org/help.html.

2) It is very difficult to get accurate, unbiased information about individual plans. Part D plan call centers are run by private companies, and a recent study by the Government Accountability Office and advocacy groups found that consumers got correct answers only one-third of the time when they called for information about drug plans. The 1-800-MEDICARE (800-633-4227) line does a better job, with two-thirds of its answers correct, the study found.

If You Have No Coverage Now

Though few, if any, consumer groups are happy with the way the Part D plan was constructed and are even less pleased with how it is being administered, they are inclined to recommend — albeit reluctantly — that Medicare recipients who do not have prescription drug coverage through an employer or a private insurer join a plan even if they currently use few if any prescription drugs.

David Lipschutz, a lawyer for California Health Advocates, a nonprofit agency that advises state health insurance and Medicare programs, said even if you do not need it now, “it’s probably a good idea to pick up a plan and pay for it as you would any other insurance policy.”

The problem is this: Say you currently take no prescription drugs or only one such drug daily, perhaps to lower blood pressure or cholesterol or relieve painful arthritis. With the monthly premium for a Part D plan, the deductible and the co-pay for each prescription, you may reap little or no benefit from being in a plan now, and may even lose money. But what if you are found to have cancer or multiple sclerosis between Jan. 1 and Nov. 15, 2007, the latter being the start of the next sign-up period? And what if the best treatment for your disease is an astronomically expensive drug? Will you be able to afford it?

Of course, the plan you signed up for in 2006 may not cover that drug, in which case you will have to file an appeal for coverage, a process that can take much longer than Part D regulations mandate. The Medicare Rights Center — 1-888-466-9050 — has a cadre of volunteer lawyers who provide free services to consumers having trouble with appeals.

In choosing a plan, start with the Medicare Web site, www.medicare.gov, and click on Medicare Prescription Drug Plan Finder. If necessary, get someone who is computer savvy to help you. When comparing plans, look not only at the premiums, deductibles and co-pays for the drugs you take, but also at the kinds of restrictions that may be placed on your drugs. Do they require prior authorization? Will you have to use “step therapy” — start with a cheaper drug and if that doesn’t do the job, will the plan cover a more costly one? Are there quantity limits?

Before signing up, double-check with the plan itself about coverage. “Last year,” Ms. Beebe said, “there were a lot of mistakes” in the plan finder. She also cautioned against being “sucked in by zero-dollar premiums offered by some managed care plans unless you determine that managed care will work for you.”

If You Currently Have Drug Benefits


You may already be in a Part D plan or have prescription drug coverage with your regular medical insurance. Perhaps your current insurer sent you a letter stating that its plan was at least as good as Medicare’s and advising you to stick with the insurance you have. In general, that is good advice.

If you have already signed up for a Part D plan, you would be wise to review the coverage you are getting. “You can’t assume that a plan that worked well this past year will work well next year,” Ms. Beebe said. “Plans change, and individuals’ needs may change. No one is free from having to go back and look at all the options to see if another Part D plan, or an outside plan, would work better for you.”

For example, the plan you signed up for may no longer cover one or more of the drugs you take. When a drug is dropped, the plan is required to provide 60 days’ notice or a 60-day supply of the drug, but beyond that it comes out of your pocket.

You have probably also heard of the “doughnut hole” in Part D plans. This is the point at which you and your insurer combined have spent $2,250 on drugs. After that, you have to pay all drug costs until you have personally spent $3,600 this year (the figure could change next year) on drugs covered by the plan.

Perhaps you bought a plan that covered both generic and brand-name drugs in the doughnut hole. But now that plan has changed and it covers only generics, or no drugs at all.


Premiums, too, may have increased, even doubled, from when you signed up. Mergers are taking place among the hundreds of companies that initially provided Part D insurance, and these can result in major changes in coverage.
__________________
You're alive. Do something. The directive in life, the moral imperative was so uncomplicated. It could be expressed in single words, not complete sentences. It sounded like this: Look. Listen. Choose. Act. ~~Barbara Hall

I long to accomplish a great and noble tasks, but it is my chief duty to accomplish humble tasks as though they were great and noble. The world is moved along, not only by the mighty shoves of its heroes, but also by the aggregate of the tiny pushes of each honest worker. ~~Helen Keller
Stitcher is offline   Reply With QuoteReply With Quote
Old 11-11-2006, 07:44 AM #5
Stitcher's Avatar
Stitcher Stitcher is offline
Magnate
 
Join Date: Aug 2006
Posts: 2,136
10 yr Member
Stitcher Stitcher is offline
Magnate
Stitcher's Avatar
 
Join Date: Aug 2006
Posts: 2,136
My Mood: 2007 Medicare Part D Open Enrollment
10 yr Member
Default

I think it is time for me to buy the bumper sticker my daughter and son in law have on their cars..."If You Aren't Outraged, You Aren't Paying Attending".

I would then insert words to make it read..."If You Aren't Outraged About Medicare's Part D Plan, You Aren't Paying Attending"

So, last night I went to the Finder to begin my search for a 2007 Part D Plan for myself. My current plan with Humana is going from $58 a month to $70.40 a month AND eliminating coverage of the "Gap", except for Generic, which the plan will continue to cover. I have nine Rx, plus two types of syringes...making nine scripts (only my test strips are covered 100% by Medicare directly). Only THREE of those Rx are covered in 2007 during the Gap as they are Generic.

My Results. A whopping 121 plans to pick through:
http://tinyurl.com/y2b9z7

I began the search here:
Medicare Prescription Drug Plan Finder
http://tinyurl.com/ybzczk
Then:
Find & Compare Plans
Then:
Continue after entering data

__________________
You're alive. Do something. The directive in life, the moral imperative was so uncomplicated. It could be expressed in single words, not complete sentences. It sounded like this: Look. Listen. Choose. Act. ~~Barbara Hall

I long to accomplish a great and noble tasks, but it is my chief duty to accomplish humble tasks as though they were great and noble. The world is moved along, not only by the mighty shoves of its heroes, but also by the aggregate of the tiny pushes of each honest worker. ~~Helen Keller
Stitcher is offline   Reply With QuoteReply With Quote
Old 11-14-2006, 08:44 AM #6
Stitcher's Avatar
Stitcher Stitcher is offline
Magnate
 
Join Date: Aug 2006
Posts: 2,136
10 yr Member
Stitcher Stitcher is offline
Magnate
Stitcher's Avatar
 
Join Date: Aug 2006
Posts: 2,136
My Mood: 2007 Medicare Part D Open Enrollment
10 yr Member
Default

Decisions about the Rock and Hard Place

So, I have reviewed my options and decided to move from Humana to AARP for RX. Primarily because the premium is less. Both cover generics ONLY during the gap.

So, now my challenge to figure out how I am going to obtain the Brand meds that are not covered during the gap...approximately $717.44...a little less than 50% of my monthly income. The one non-covered med that infuriates me is my insulin, which will cost me $80.20 a month. This is a life saving medication, not a medication to help with symptoms...infuriating...and not available as a sample from a physician.

Yes, there are FREE meds programs out there, but they are based on income, typically at poverty level...which I believe is $11,500...and that is far less than my income. So, I don't qualify for those. I will turn now to my personal physicians and request monthly samples from them beginning in March 2007 , when the GAP hits me hard .

Here is detailed information about the PENALTY imposed by Medicare Part D if you don't enroll timely when you become qualified to do so:

Late enrollment penalty of 1% adds up!

If you choose not to enroll in a Medicare Part D plan when eligible, Medicare may require you to pay a higher premium if you decide to join after your initial enrollment period. Unless you already have prescription coverage that’s as good as a Medicare Part D plan, you could incur Medicare’s late enrollment penalty that is equal to about one percent of the national average premium per month, or 12% per year. To confirm whether your prescription coverage is as good as a Medicare Part D plan, call 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week. TTY/TDD users call 1-877-486-2048.
Example:

If you decide to join a plan three years after becoming eligible, the late enrollment penalty would cause your premium to be about 36 percent higher (one percent per month x 36 months).
3-year Penalty: 1% per month x 36 months = 36% increase in premium

The national average for premiums offered in 2007 is $27.35 per month or $328.20 per year. With a 3-year late enrollment penalty, you would pay about $37.20 per month or $446.40 per year. Your premium will remain higher for as long as you stay in a Medicare Part D plan, so it pays to enroll when eligible.
p.s. I am compiling information about FREE RX programs and will post in the stickie note section as soon as it is complete. If anyone has suggestion to include in that stickie note, please send them to me.
__________________
You're alive. Do something. The directive in life, the moral imperative was so uncomplicated. It could be expressed in single words, not complete sentences. It sounded like this: Look. Listen. Choose. Act. ~~Barbara Hall

I long to accomplish a great and noble tasks, but it is my chief duty to accomplish humble tasks as though they were great and noble. The world is moved along, not only by the mighty shoves of its heroes, but also by the aggregate of the tiny pushes of each honest worker. ~~Helen Keller
Stitcher is offline   Reply With QuoteReply With Quote
Old 11-29-2006, 03:16 PM #7
Stitcher's Avatar
Stitcher Stitcher is offline
Magnate
 
Join Date: Aug 2006
Posts: 2,136
10 yr Member
Stitcher Stitcher is offline
Magnate
Stitcher's Avatar
 
Join Date: Aug 2006
Posts: 2,136
My Mood: 2007 Medicare Part D Open Enrollment
10 yr Member
Default

Insurer scales back, widening Medicare prescription gap

The Humana plan, used by many seniors to bridge the 'doughnut hole,'
will no longer pay for brand-name drugs.

By Ricardo Alonso-Zaldivar, Times Staff Writer
LA Times
November 29, 2006

http://www.latimes.com/news/printedi...ck=1&cset=true

WASHINGTON — Seniors wanting to avoid the Medicare prescription
program's coverage gap have had one clear alternative: Choose a plan
that cost more but bridged the break in benefits.

But that option will be more restricted and more expensive next year.
The leading national plan that covers brand and generic drugs in the
gap — Humana PDP Complete — will no longer pay for brand-name
prescriptions.

More than 410,000 seniors in the plan will face higher premiums and
only be covered for generics in the coverage gap. Or, they can shop
for another insurer. In some states, no plan will be available next
year that covers brand-name medications in the gap.

Louisville-based Humana's decision to scale back its coverage raises
a new complication for Democrats vowing to reform the prescription
program, experts say. The party, which will take control of Congress
in January, has focused on authorizing Medicare to negotiate lower
prices with drug makers.

Humana's decision shows that the actions of insurers — the private
middlemen who deliver the benefit — also can have a profound effect
on seniors' pocketbooks. Negotiations with drug manufacturers may or
may not resolve such problems.

"When an insurance company has a plan design that it cannot make
money on, it can be pretty ruthless in what it does to correct that,"
said Robert Laszewski, a healthcare industry consultant. Humana said
recently it had paid out $1.33 in benefits for every $1 it took in
this year under the PDP Complete plan.

Generic drugs, usually copies of brand-name drugs on which the
patents have expired, cost a lot less. But no generics are available
for relatively new drugs, including many medicines for conditions
ranging from cancer to psychiatric problems.

Moe Tawil, 70, a retired engineer from Manhattan Beach, says he can
understand why the insurer would need to raise premiums, but he
questions the decision to curtail coverage of brand-name drugs.

"The fact that the plan can significantly change is at best annoying,
and at worst it can create quite a problem for some people," he
said. "It just causes a tremendous amount of confusion and heartache.
You don't buy auto insurance to have them tell you, 'By the way,
we're not going to cover collision next year.' "

Tawil's wife, Barbara, is on Femara, a pill taken daily to prevent
the recurrence of breast cancer. Considered more effective than
tamoxifen, the medication costs more than $700 for a 90-day supply.
The Tawils now pay $150 through her PDP Complete plan. There is no
generic equivalent for Femara, which is manufactured by Novartis.

"I went through a lot this year to find this plan, and I certainly
don't want a plan that won't cover one of my medications," Barbara
Tawil said. "I would like some consistency in coverage for next year."

Although the Medicare prescription program has proved popular among
seniors, the coverage gap known as the doughnut hole remains a
challenge. Congress designed the break in benefits to cut program
costs, and then indexed the gap for inflation.

That means the doughnut hole will widen next year, to just over
$3,050 from the current $2,850. When a beneficiary reaches $2,400 in
total drugs costs, no coverage is provided until the person reaches
$5,451.25 in costs. After that, Medicare pays 95%.

Although more plans will offer coverage of generic drugs in the gap
next year, the number covering brand-name medications will drop from
33 to 27. Fewer than one-third of Medicare prescription plans offer
any sort of coverage in the gap, according to a recent study for the
Kaiser Family Foundation.

Some advocates for seniors say insurers have engaged in misleading
marketing.

"This illustrates the exploitative marketplace older Americans are
facing," said Robert M. Hayes, president of the Medicare Rights
Center, a New York advocacy group. "The marketing strategy was
premised on bait-and-switch, aggressive marketing and low premiums in
Year One to bring the customer in, and then reduced benefits and
increased costs."

Humana rejects that charge.

"After reviewing the 2006 experience with our complete plan that
covered brand drugs through the coverage gap, it became clear to us
that we could not continue to do that in 2007 and be able to offer it
at an affordable premium," spokesman **** Brown said.

"When we bid for the 2006 plans," Brown said, "we assumed other
companies would do as we did and offer one plan that covered brand
drugs through the gap. That did not happen. We under-priced the plan
based on that erroneous assumption. In short, our scenario just did
not play out as we assumed."

A Medicare official declined to comment. The agency has been
stressing the growing availability of coverage for generics in the
gap.
Seniors who want to switch from Humana's PDP Complete plan have until
Dec. 31 to do so, although Medicare is recommending they act by Dec.
8 to avoid possible problems at the pharmacy in January.

However, Medicare may have inadvertently added to the confusion by
telling seniors they don't have to switch if they are satisfied with
their current plan, Hayes said. "Many people will just sit still," he
added.

Although Democrats have not directly addressed the issue of
disruptions in coverage, one of the plans they are discussing might
offer a remedy.

Sen. Richard J. Durbin (D-Ill.) and Rep. Pete Stark (D-Fremont) have
called for Medicare to set up a government-administered prescription
plan to compete with the private ones. Such a government plan would
not have to make a profit, and could be set up to provide stable
coverage from year to year.

"If done properly, it could offer a safe haven," Hayes said.
__________________
You're alive. Do something. The directive in life, the moral imperative was so uncomplicated. It could be expressed in single words, not complete sentences. It sounded like this: Look. Listen. Choose. Act. ~~Barbara Hall

I long to accomplish a great and noble tasks, but it is my chief duty to accomplish humble tasks as though they were great and noble. The world is moved along, not only by the mighty shoves of its heroes, but also by the aggregate of the tiny pushes of each honest worker. ~~Helen Keller
Stitcher is offline   Reply With QuoteReply With Quote
Reply

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
USA: Medicare and You / Part D Prescription Plan Stitcher Parkinson's Disease 1 11-04-2007 10:43 PM
ticked again ( part 2) Curious Survivors of Suicide 7 10-18-2006 10:30 AM
MJFFoundation Seeks Novel Drug Development Strategies for 2007 Target Val Stitcher Parkinson's Disease 1 10-13-2006 08:00 AM


All times are GMT -5. The time now is 11:31 AM.

Powered by vBulletin • Copyright ©2000 - 2020, Jelsoft Enterprises Ltd.

vBulletin Optimisation provided by vB Optimise v2.7.1 (Lite) - vBulletin Mods & Addons Copyright © 2020 DragonByte Technologies Ltd.
 

NeuroTalk Forums

Helping support those with neurological and related conditions.

 

The material on this site is for informational purposes only,
and is not a substitute for medical advice, diagnosis or treatment
provided by a qualified health care provider.


Always consult your doctor before trying anything you read here.