....Separated at birth?.....

Song in my head: Strumming my pain with his fingers...Singing my life with his words...Killing me softly with his song .....Roberta Flack


Medicareless, continued again.

Since my last episode of filling prescriptions, I have had some success. I finally was reimbursed for my out of pocket expenses I incurred by paying for my medicine myself. My bill was $9.00 2 dollars for fluoxetine, 2 dollars for amitryptylene, and 5 dollars for Maxalt. Now that I can afford....as opposed to their full price of about $175. Because I am low income I do not have to worry about the donut hole gap in drug coverage, or the $250 deductible. I got this information from Clear Choice, my supplemental medicare provider at one of their "town hall meetings". at allThe 2006 Medicare handbook does not explain this. Folks in mid level incomes are getting hosed by the $250 deductibe, $37 monthly premium payment, and a coverage gap after you incur $2251 worth of medications from your approved plan. What drugs you pay out of your plan does not count for your deductible.

As I'm reading the 2006 mediacre handibook I noticed a provision that one would find interesting as a future customer of Medicare or if I was considering boycotting the plan altogether ...It reads:

If you don't use a lot of prescription drugs now, you should still still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means that you will not have to pay a penalty if you choose to join later. Your premium would be higher if you wait to join after May 15, 2006 because of the penalty.

Say I'm a healthy senior citizen currently not taking any medications now but get a serious infection. You either pay full price for the meds or join a medicare drug plan with a penalty. The penalty is 1% per month after May 15....of your supplemental medicare premium. For example my monthly premium is $82.50. If I didn't get an infection and sign up for a medicare drug plan until July 15, of the same year, I would incur 1% of $82.50 per month with NO limit. That is a penalty of $.835 a month! $1.65 if you are 2 months late...my premium increases from $82.50 to $84.15 a month (That is what my notes say from this town hall meeting I went to months ago and I will not vouch for their accuracy because they already lied to me...update: see page 40 in the 2006 Medicare handbook). (ed. 1/25:updated with correct figures today....see this web site for more about penalties incurred and how nebulous the law is about penalties. Here is another example of the penalty incurred if you sign up late for Medicare Part D, here. As you can see it is very confusing.)

It's important to note that I am on a supplemental Medicare plan along with Medicare which covers doctor visits, hospital visits, lab work, and medicine. Medicare and my supplemental policy still doesn't cover dental, optholmogists, maternity care, or birth control. I do get eye coverage because of glaucoma, which is deemed medically necessary.

Read more at Obsidian Wings, where Hilzoy explains way better than I can how stopping anti-depressants sets us back and disrupts our everyday living and other loopholes in the Medicare part D plan. And what she describes aint pretty.

But there are a lot of other diseases in which not taking your medications can make you relapse, and though the relapse is not necessarily life-threatening, it does alter your body and your life in ways that are hard or impossible to undo. Some of the most severe mental illnesses, for instance, have this property: that each relapse not only wreaks havoc with your life directly, but also sets your recovery back a lot, and (often) makes the level you can recover to worse than it would have been otherwise.


TPMCafe has started a Drug Bill Debacle Blog

Medicare Part D Horror stories....You got any to contribute? I read yesterday that 24 states are now helping their state's citizens get the medicines many so depend on for ther health and well being.

Staying Alive, a health care policy blog...Can These Clowns Do Anything Right?...And a great monkey pic.

Matthew Yglesias...Prescription drugs... not a good Dem issue in 2008 elections....others differ..

The Republican's Poison Pill


Jo Phish: The 1600 crew, never a group to miss the opportunity to put Politics ahead of Policy went to the mat to give Preznit Utterly Corrupt a campaign talking-point on his "Medicare Reform", has demonstrated how much they are in the pockets of their biggest contributors with their "reform". They have managed to fuck over a whole generation of Americans, "fixing" a problem by destroying an institution. Gee, this makes reforming FEMA look like a relative success.

There are an assortment of flaws in the new medicare drug plan, however, I was too stressed to cover a lot of them. Just enduring the hassle of assuring access to affordable medication the last 2 weeks was all my fatigued body can take. I really have no idea what will happen when I go back to the pharmacy early next month. But, when I look back at the whole affair I feel it is my supplemental medicare provider that is to blame. As Kevin Drum explains conventional wisdom is that the pharmacy companies are profiting greatly from the medicare drug plan. The reality: the insurance companies....

The conventional wisdom about the Medicare prescription drug bill is that it was a huge giveaway to the pharmaceutical industry. And it was. But the real payoff was to the insurance industry, one of the Republican Party's favorite special interest groups.

I agree. And it is my insurance company to blame for 3 days of hell without my migraine meds. As I was doing some research on Medicare the other day I found this: A memo to all part D sponsors on transitional policies. I don't know how to cut and paste this pdf file but I quote from the memo from the Center for Medicare and MedicaidServices, dated January 6, 2006:

As we have enphasized on previous plan user calls, we expect that Part D sponsors will use sound business and clinical decision making when adminestering transitional supplies and not place the burden on beneficiaries during the implementation of the benefit.

That was not done at all. I called my Part D sponsor and they flat out refused to cover my meds. The memo stresses this point:

We must stress that delaying or denying the filling of initial prescriptions for new enrolees at point-of-sale-because of prior authorization/step edit requirements is not consistent with the intent of CMS' transition policy.