In 2006, everyone on Medicare was told they should enroll in a Part D drug plan. This new benefit would be a big help to seniors who had no retirement plan that covered their prescriptions.  But instead of the government offering one plan for everyone, Part D was turned over to insurance companies.  In Pima county there are 46 Part D plans available, according to the medicare.gov website.

In 2006, Part D plans cost between $10 and $20 per month.  Since 2006, premiums have risen each year, and in 2010 the average plan will cost around $35 per month. Many plans are even higher. 

Each company decides what drugs to include on its “formulary”, and some Part D plans cover only 75% of Medicare-approved drugs. But their marketing materials don’t provide a list of drugs they DON’T cover.

When I look into a drug plan for a client, I get a list of their medications and go to the medicare.gov website. I click on the link for “Compare drug plans”, enter a zip code, age, and other information, and finally get to a page where I can enter my client’s prescription details. The program will then produce a list of plans that cover their drugs.  This is pretty cool, but there is a problem I have discovered.

The plan that might be the lowest priced (say Unicare for $25.10/month) might cover a person’s drug list this year.  But what if their prescriptions change in July and they discover the plan does not cover a drug prescribed by their doctor?  For example, the Unicare plan (owned by Wellpoint, the largest insurance company in the U.S.) seemed like a good deal for two of my clients.  But when I went to the Unicare site and entered other clients’ drug lists, I discovered this plan doesn’t cover drugs such as Actonel, Aciphex, and Crestor.  Who knows what else they don’t cover? That’s when I started to worry that this plan might have problems down the road.

I guess you just have to take your chances, enroll in a plan, and hope it works out for you over the next year – because you cannot change your stand-alone Part D plan until next year at this time.

Why does it have to be so complicated? Why are there 46 plans offered in Pima county? Why is the cost going up every year?  The answer is…..because Medicare turned this benefit over to private insurance companies.   Another problem is that the law that created Part D specifically stated that Medicare is not allowed to negotiate drug prices with pharmaceutical companies – so this is why costs are going up each year.  And here’s another thought…..With Part D premiums going up each year, it makes Medicare Advantage plans (which include a drug plan) look more attractive when it comes to cost.

Now that I’m venting…..it is my belief that the introduction of Part D was a clever conspiracy between drug companies and insurance companies to bring billions of dollars of business their way.  You see, with the Part D, seniors could afford prescriptions they might have turned down previously. This increased drug sales for Big Pharma.  And with insurance companies offering Part D, this opened the door to sign people up for Medicare Advantage plans.  Why pay $15 or $35 for a stand-alone Part D plan (plus $100 or more for a Medicare Supplement) when I can sign you up for a Medicare Advantage plan with no monthly premium?

What a complicated mess they have made of Medicare.

This entry was posted on Sunday, December 13th, 2009 at 12:50 pm and is filed under Health. Tags for this post: Healthcare reform, Medicare, Medicare Advantage, medicare advantage arizona, medicare advantage tucson, medicare arizona, medicare change, Medicare Supplement, medicare tucson, part d, part d help. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.