February, 2006
"Up is down and down is up," said the Jabberwock in Lewis Carroll's Alice Through the Looking Glass (if I remember my literature correctly). I wonder if Mr. Carroll had some advance warning about the new Medicare Part D, also known as the Medicare Prescription Drug Improvement and Modernization Act of 2003. I say this, because like many others who are trying to understand this new law, I feel like we have just entered a surreal world of dead ends, mirages and hallucinations. But my problems are minor compared to the seniors and people with disabilities that now are covered by this law. For them 2006 really started out with a bang.
If I understand it correctly, the purpose of this law is to expand benefits for Medicare beneficiaries to cover prescription medication and save the individuals on their drug costs. An admirable plan for a government program, and in the long run, this plan may actually do what it is intended to do. But in the short term it seems to have created a real "Wonderland" for Medicare recipients. For several months now the Health Care Insurance and Advocacy Program (HICAP) has been providing trainings and information to the general public and organizations on Medicare Part D. If you are still are in need of assistance or want to schedule a presentation with someone to speak to your group, then give them a call at 462-5510. But I digress from our chase of the rabbit.
As you may have seen in previous articles in various publications, many people who qualify for both Medi-Cal and Medicare (often referred to as MediMedi) have become lost in the "wonderland" of bureaucracy. This applies to approximately 1 million Californians. If they had been getting their medications from Medi-Cal they now find themselves getting them through Medicare. No problem, you say? Wrong. What used to be no cost under Medi-Cal now has a $1-5 share of cost under Medicare Part D. Now this may not sound like much, but if you are taking several medications, then the total can really eat into your Social Security. Part of the plan does offer low-income assistance, but getting this verified and approved is also proving to be a problem. You also get to choose from 48 plans, each one presented by a different insurance company. Each plan has to cover every class of drugs, but it might not carry your particular drug (which you have taken for all these years and feel really comfortable with) or it may not be accepted by the pharmacy of your choice.
I spoke with a couple of pharmacists and am told they have experienced several problems. There are too many options in the plans, each insurance company has there own software and if even one keystroke is off then the order is rejected, insurance companies have been understaffed and did not anticipate the crash of calls and enrollments, thus causing panic - and this is only on the public side. The pharmacies have had to increase their staffing, phone calls to insurance companies or government agencies are taking over 30 minutes, and agencies can't seem to agree on information. Pharmacies may also be getting reimbursed less under the new plan. Just as a footnote, the Center for Medicare and Medicaid Services just increased their hotline staffing from 150 to 4,500. Don't you just love prior planning?
On the bright side they are beginning to see the initial onslaught subside, calls are being answered more promptly, California has joined other states in authorizing emergency action to insure that people do not go without their medications and then seek reimbursement from the Feds later.
If you're a senior and receive only Medicare there is still time to research and
get signed up. You don't have to choose a plan until May. Please don't wait
until the last minute. Seek assistance - call HICAP at 462-5510 or the Central
Coast Alliance for Health at 430-5500. You can also go on-line at www.medicare.gov.
I guess after we've waltzed around this wonderland with the Cheshire Cat and
Queen of Hearts for a little while and experienced the surreality of a government
plan run amok we can return to reality and get back to living independently in
this wonderful area. Remember - Disability is a random
event that can occur in any life, at any moment.
- Michael Bradshaw, Central Coast Center for Independent Living