The Medicare Prescription Card Maze
I wrote this June 29, 2004, and it was published in the Venice (Florida) Gondolier newspaper. In spite of my frustration at the time I wrote this, I've come to consider the Medicare prescription benefit as President Bush's best legacy.
Changes in Medicare that were enacted last year provide a limited prescription drug benefit beginning in 2006, and promote the use of “Medicare Approved” drug discount cards in the meantime. Unfortunately, the process of enrolling for one of the approximately 75 approved discount cards is so complex, and there is so much uncertainty about what is being offered, that many seniors may opt to just give up and do without.
When my 87-year old mother tried to enroll by telephone she never succeeded in talking to a living human being. She eventually gave up in the face of lengthy holds and numerous automated options, and asked me if I would help her via internet.
What an experience that was! We finally succeeded, but the process required us to visit two web sites and a search engine; provide information and make choices via a lengthy interactive program; download, complete, sign, copy and mail a form; and--for peace of mind--call her pharmacy. We worked on it off and on for two days. At the end, mom’s pharmacy said they’d received no guidance from their headquarters regarding which cards they’re accepting, but that it was “probably” a safe bet that they were accepting her chosen card if the Medicare website said they were.
It’s hard to know what the U.S. Congress and the Health and Human Services bureaucracy were thinking about when they passed and implemented this legislation. While many of us younger seniors are fairly internet savvy most older seniors aren’t, and those that are savvy may not be the lower income seniors who could most benefit. Why didn’t they provide adequate telephone support? Did our officials seriously think that most seniors would be able and willing to navigate this internet maze?
Moreover, why did they require seniors to lock into one of these cards for the entire year, but allow the card companies and pharmacies to change their prices and coverage at will? This is commonly called “buying a pig in a poke”. The kindest explanation is that they were (and seemingly still are) extremely out of touch with their senior citizen constituency, and the worst is that the whole thing was just smoke and mirrors to create the impression of doing something for seniors before the 2004 elections.
That having been said, if you think you have the skills, internet access and patience, or if you have a helper who does, it is probably well worth enrolling for one of the approved drug discount cards. In addition to possibly receiving discounts on drug prices, enrolled seniors with annual incomes below $12,569 ($16,862 for a married couple) may qualify for a $600 annual credit toward the cost of drugs.
There are two ways of contacting Medicare to start the enrollment process: by telephone (1-800-633-4227) or by internet (www.medicare.gov). Via internet, a good procedure is:
First, use the Medicare website to choose a card and download the enrollment form.
Second, use a search engine to find the internet address for the card issuer, and visit their website to check them out and confirm the card information from the Medicare website.
Third, contact your pharmacy to confirm that they’re accepting the card you’ve chosen.
Fourth, fill out, sign and copy the enrollment form, and send it to the card issuer using their instructions. If your income is more than the limits stated above you may be required to pay an annual fee of up to $30. They say the cards should arrive in 2-6 weeks.
Finally, take the card to your pharmacy, and good luck!
Copyright 2004 by Nelson E. Hay
Changes in Medicare that were enacted last year provide a limited prescription drug benefit beginning in 2006, and promote the use of “Medicare Approved” drug discount cards in the meantime. Unfortunately, the process of enrolling for one of the approximately 75 approved discount cards is so complex, and there is so much uncertainty about what is being offered, that many seniors may opt to just give up and do without.
When my 87-year old mother tried to enroll by telephone she never succeeded in talking to a living human being. She eventually gave up in the face of lengthy holds and numerous automated options, and asked me if I would help her via internet.
What an experience that was! We finally succeeded, but the process required us to visit two web sites and a search engine; provide information and make choices via a lengthy interactive program; download, complete, sign, copy and mail a form; and--for peace of mind--call her pharmacy. We worked on it off and on for two days. At the end, mom’s pharmacy said they’d received no guidance from their headquarters regarding which cards they’re accepting, but that it was “probably” a safe bet that they were accepting her chosen card if the Medicare website said they were.
It’s hard to know what the U.S. Congress and the Health and Human Services bureaucracy were thinking about when they passed and implemented this legislation. While many of us younger seniors are fairly internet savvy most older seniors aren’t, and those that are savvy may not be the lower income seniors who could most benefit. Why didn’t they provide adequate telephone support? Did our officials seriously think that most seniors would be able and willing to navigate this internet maze?
Moreover, why did they require seniors to lock into one of these cards for the entire year, but allow the card companies and pharmacies to change their prices and coverage at will? This is commonly called “buying a pig in a poke”. The kindest explanation is that they were (and seemingly still are) extremely out of touch with their senior citizen constituency, and the worst is that the whole thing was just smoke and mirrors to create the impression of doing something for seniors before the 2004 elections.
That having been said, if you think you have the skills, internet access and patience, or if you have a helper who does, it is probably well worth enrolling for one of the approved drug discount cards. In addition to possibly receiving discounts on drug prices, enrolled seniors with annual incomes below $12,569 ($16,862 for a married couple) may qualify for a $600 annual credit toward the cost of drugs.
There are two ways of contacting Medicare to start the enrollment process: by telephone (1-800-633-4227) or by internet (www.medicare.gov). Via internet, a good procedure is:
First, use the Medicare website to choose a card and download the enrollment form.
Second, use a search engine to find the internet address for the card issuer, and visit their website to check them out and confirm the card information from the Medicare website.
Third, contact your pharmacy to confirm that they’re accepting the card you’ve chosen.
Fourth, fill out, sign and copy the enrollment form, and send it to the card issuer using their instructions. If your income is more than the limits stated above you may be required to pay an annual fee of up to $30. They say the cards should arrive in 2-6 weeks.
Finally, take the card to your pharmacy, and good luck!
Copyright 2004 by Nelson E. Hay
posted by Nelson Hay | 10:35 PM
1 Comments:
Nelson, you say in your blog that "...It is hard to know what the U.S. Congress and Health and Human Services Department were thinking when they passed this legislation." The only answer I can come up with is that they were "thinking" of the best interests of the health insurance companies who insisted on a piece of the action on the Medicare drug benefit. If I remember correctly, another part of this same legislation forbad negotiation with drug companies to achieve the lowest possible pricing. To me, it seems clear that the drug benefit, and indeed all health care, in the United States would be most efficiently delivered using a single payer system. It also seems clear that what we need as a civilized society is universal health care as a basic human right, and that should include prescriptions. Although the cost would be significant, and possibly require a reorientation of national priorities, I believe that health (and education) of citizens are the highest priorities, and indeed would enhance the long term strength of the country. My understanding is that as much as 15% of all health care cost is consumed by administration and overhead relative to health insurance claims anyway, and a lot of that is action by insurance companies to deny care, not provide it, so the increased cost of universal health care including medicines might not be very much after all.
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