Watchdog Blog

Saul Friedman: Medicare Choices–Are They Necessary?

Posted at 11:04 am, September 27th, 2008
Saul Friedman Mug

This is the time of the year the government perpetuates a problem for millions of Americans, and most of the press goes along because of its superficial knowledge. The issue is Medicare Part D, which too few of my colleagues in the press know about.

Each year since the Part D drug benefit, passed by Republicans in the 2003 Medicare Modernization Act, became effective, the Centers for Medicare and Medicaid Services (CMS) provides beneficiaries with lists of the private insurance companies offering coverage. There are two basic types: There are Part D Plans (PDP), stand-alone, drugs only coverage for people who have Medicare or other insurance to cover physician, hospital and other medical needs. And there are Medicare Advantage (MA) plans of various kinds, to cover drugs and comprehensive medical needs, for which private insurers get a government subsidy in addition to payments from subscribers..

This is an important time of the year, for Medicare beneficiaries can begin enrolling in or changing to one of these plans between Nov. 15 and Dec. 31. Kerry Weems, the acting CMS administrator announced, as has become routine, that the monthly premiums will increase by from $18 to $21 on average for MA plans, and $27 to $32 on average for drugs only plans.

But the best news according to CMS, faithfully reported in very straight stories, is that 44 million beneficiaries will have “choice,” which, Weems said , is the “engine behind Part D.” Choice was the magic word the Republicans used to sell the privatized Part D. And the AP reported, without comment or elaboration, that “the typical beneficiary will still have dozens upon dozens to choose from.”

Well, the “typical beneficiary” is a person well over 65, not necessarily in the best of health, perhaps disabled. He or she knows far less than Weems, but I doubt that he will find it easy to choose. For I counted on the CMS web site (which most seniors can’t use) and there are 113,014 MA plans to choose from nationally, and 2,569 drugs only plans.

Alabama has 1,938 MA plans and 52 drugs only plans. New York has 3,228 MA plans and 50 drugs only plans. And each county has dozens of choices, with prices and benefits differing from a neighboring county. A reporter can see them all here and consider for beneficiaries whether choice and competition among private insurers is helpful for the elderly, or whether a rational, uniform government administered benefit under Medicare makes more sense.

2 Responses to “Medicare Choices–Are They Necessary?”

  1. DeanOR says:

    Medicare has an online tool for comparing the costs and benefits of various prescription plans that are available in one’s geographic location. The last time I used the tool, it rated my Medicare plan as the most expensive one in the region for my prescriptions. It is actually the least expensive for prescriptions. The catch is that the plan requires physician approval for non-formulary drugs. The online tool assumes that the patient will have to pay full price for those drugs. In fact, the plan physicians almost always give approval, without even being asked. I am a retired health care professional with a PhD, and the array of choices and rules can be bewildering even for me. I shudder to think what it must be like for some elders.

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