Examining Part D
This week-end is going to be devoted to trying to sort out whether or not it will be advantageous to enroll in Part D of the Medicare system, then if yes, trying to determine which plan available in my area will offer the best savings.
This has been complicated by the design of the program structured by the lobbyists from Pharma and Insurance entities through their legislative slaves in the Congress. I happened to be viewing C-Span during the shenanigans employed to ram this through, the ignoring voting time limits, the bribing and political threats employed to satisfy the campaign funding rulers of the House of Representatives.
My thought is that for all the time I may spend trying to choose the best from the unnecessary multitude of details, that in 2006, hopefully the elections will change the majority in Congress to Democrats who will then probably put through a revision, given all the flack that is coming from the senior community that has a high participatory level in elections.
I interact online in three to four health forums because of my specific conditions, and everyone sees that the legislation does not give a fair break over the pharmacy and insurance industries, to the participants.
The supplier/providers can change the formularies at will, true they are required to notify you but if a needed medication disappears from the list, you are not allowed to immediately seek enrollment in another where the prescription is included, not until the annual open enrollment period in Nov-Dec annually can one enrollee change, and the same predicament exists with other details.
Coercion is explicit - if you don't like it and want to wait to see how it shakes out, it will cost you an additional 1% per month, therefore 12 per cent per annum, on the premium. That's decidedly unfair, particularly when there is not recovery of premium if the plan fails to deliver as promised. There are plans that cover the deductible and those that do not. Co-pays are determined by assigning tiered categories, and another coercive feature is that the lowest co-pays are for generics, meaning that it may be advisable to watch what the market does to those manufacturers. Maybe we can earn some money to pay the co-pay for the brand name or the drugs that someone else has decided has to be placed in a Quantity Review on limits or a Step category where someone other than your treating physician will decide that you must try some other drug! Astounding that this is legal, isn't that practicing with out a license?????
Can you see how this is going to affect the prescribing proclivities of your primary physician?
We should not need to contend with such manipulation. Handling a chronic disease is time consuming as well as costly and many seniors have them in one or more categories, pulmonary, cardiac etc, or worse afflictions such as cancer and rare diseases that may strike the senior population moreso than the general public.
I will begin the process armed with my list of current Rx's (here's another part of the snakepit) we must choose based on conditions that are quite subject to change on your next visit to one of your doctors. This just happened to me. I had just purchased a 90 day supply of a certain prescription and the doctor has decided that a new one may work better in my particular case, see how improbable again it is that after going through a time consuming process of trying to make the best possible choice in a terribly designed plan, it can be for naught?
Off I go, to see what plans are available in my particular state, determine if my Rx's are on the forumulary and at what tier of co-pay, compare them all, investigate the reliability of the corporate background of the insurer, (looked at one where I don't care what their plan is, I won't buy in because of the millions paid to the CEO- I have a social conscience even it he doesn't).
Also it will require a probable three week processing period so those who are going to enroll to get their card etc by January 1.2006 when the benefits(?) begin, you need to consider that also if current meds need replenished before the May 15, 2006 enrolment deadline. I am unsure if there is open enrollment in Nov-Dec 2006, will look for that fact and see what I can find.
It will be interesting if I can predict when I will tumble into the donut trap.I'm already engulfed in too many traps.
Wish me luck!
graysmoke
This has been complicated by the design of the program structured by the lobbyists from Pharma and Insurance entities through their legislative slaves in the Congress. I happened to be viewing C-Span during the shenanigans employed to ram this through, the ignoring voting time limits, the bribing and political threats employed to satisfy the campaign funding rulers of the House of Representatives.
My thought is that for all the time I may spend trying to choose the best from the unnecessary multitude of details, that in 2006, hopefully the elections will change the majority in Congress to Democrats who will then probably put through a revision, given all the flack that is coming from the senior community that has a high participatory level in elections.
I interact online in three to four health forums because of my specific conditions, and everyone sees that the legislation does not give a fair break over the pharmacy and insurance industries, to the participants.
The supplier/providers can change the formularies at will, true they are required to notify you but if a needed medication disappears from the list, you are not allowed to immediately seek enrollment in another where the prescription is included, not until the annual open enrollment period in Nov-Dec annually can one enrollee change, and the same predicament exists with other details.
Coercion is explicit - if you don't like it and want to wait to see how it shakes out, it will cost you an additional 1% per month, therefore 12 per cent per annum, on the premium. That's decidedly unfair, particularly when there is not recovery of premium if the plan fails to deliver as promised. There are plans that cover the deductible and those that do not. Co-pays are determined by assigning tiered categories, and another coercive feature is that the lowest co-pays are for generics, meaning that it may be advisable to watch what the market does to those manufacturers. Maybe we can earn some money to pay the co-pay for the brand name or the drugs that someone else has decided has to be placed in a Quantity Review on limits or a Step category where someone other than your treating physician will decide that you must try some other drug! Astounding that this is legal, isn't that practicing with out a license?????
Can you see how this is going to affect the prescribing proclivities of your primary physician?
We should not need to contend with such manipulation. Handling a chronic disease is time consuming as well as costly and many seniors have them in one or more categories, pulmonary, cardiac etc, or worse afflictions such as cancer and rare diseases that may strike the senior population moreso than the general public.
I will begin the process armed with my list of current Rx's (here's another part of the snakepit) we must choose based on conditions that are quite subject to change on your next visit to one of your doctors. This just happened to me. I had just purchased a 90 day supply of a certain prescription and the doctor has decided that a new one may work better in my particular case, see how improbable again it is that after going through a time consuming process of trying to make the best possible choice in a terribly designed plan, it can be for naught?
Off I go, to see what plans are available in my particular state, determine if my Rx's are on the forumulary and at what tier of co-pay, compare them all, investigate the reliability of the corporate background of the insurer, (looked at one where I don't care what their plan is, I won't buy in because of the millions paid to the CEO- I have a social conscience even it he doesn't).
Also it will require a probable three week processing period so those who are going to enroll to get their card etc by January 1.2006 when the benefits(?) begin, you need to consider that also if current meds need replenished before the May 15, 2006 enrolment deadline. I am unsure if there is open enrollment in Nov-Dec 2006, will look for that fact and see what I can find.
It will be interesting if I can predict when I will tumble into the donut trap.I'm already engulfed in too many traps.
Wish me luck!
graysmoke
posted by graysmoke @ 1:34 PM
1 Comments:
At 10:00 AM ,
graysmoke said...
This is graysmoke, thanks for commenting on my blog. Yours is a refreshing read, quite a difference in views with half a century of difference in our ages!
May all be well with you and your future fiancee, I'll check in from time to time.
Maybe you would like to read my personal web pages - (OOPS)I think this comment will be lost if I minimize and go to get url, it's also buried somewhere I think in one of my blogs.
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