HOW SHE SEES IT New Medicare plan will hurt seniors

By MARY E. O'BRIEN
KNIGHT RIDDER/TRIBUNE
The Medicare Part D prescription plan is forcing the elderly into a bewildering array of private prescription plans that even I, a seasoned physician, find hard to interpret.
The plan is not truly an effort to provide affordable drug coverage to seniors. Instead, it is an exorbitant giveaway to the private insurance industry and the pharmaceutical companies, and a Trojan horse designed to destroy the entire Medicare system.
No governmental attempt was made to negotiate lower drug prices, and the prescription plans are offered exclusively by private insurance companies with high administrative costs with a for-profit market approach.
Medicare today is an efficient public system that is almost automatic for seniors. But the prescription drug plan hopelessly complicates matters for seniors. And it's no cheap treat.
The standard Medicare part D guidelines require seniors to pay the first $250 of their annual medication costs. They will then face a 25 percent co-pay for the next $2,000 of drug expenses. At this point they enter what is called the "doughnut hole," where they have no coverage and pay 100 percent of their drug costs until they reach a total of $3,650 out of pocket.
Then, if they are part of the tiny 5 percent of seniors whose annual drug costs exceed $5,000, they will obtain catastrophic coverage and pay 5 percent of the remainder of their annual drug costs.
However, if the patient's medications are not part of his or her selected plan's formulary, the patient will end up paying the entire cost of the medication and these costs won't be counted toward his or her $3,650 out-of-pocket maximum.
No wonder seniors are angry and confused.
About 10 million retirees receive drug coverage through their former employers. If their coverage is deemed at least as good as the minimal Medicare benefit, they can keep this plan and forgo the Plan D benefits.
But if they have no drug coverage, they must choose a private plan by May 15, 2006, or face a usurious financial penalty of 1 percent of premium costs for every month that they delay, which will be added to their part D premiums.
There are two types of Part D coverage: One type is a stand-alone Prescription Drug Plan (PDP) that can be used with traditional Medicare fee-for-service plans. The other type is an all-inclusive private Medicare managed care plan with drug coverage.
Underhanded plan
Seniors, be especially wary of the effort to lure you entirely into the private sector. The Bush administration has an underhanded plan to destroy Medicare as a public system affording equal coverage to everyone. It hopes to dismantle Medicare by pushing people who want simpler drug coverage into for-profit HMOs that have no permanent benefit guarantees.
When you decide to choose a plan, you will need to look closely at the drug formulary to see if your medications are covered. You'll need to understand the three-tiered co-pay structure with increasing co-payments for drugs in the higher tiers.
There are also drugs that require preauthorization, drugs whose dosage and the quantity of pills allowed will be limited and step-therapy drugs for which you will need to try several cheaper drugs first before your medication will be approved.
These plans can change their benefits and formularies throughout the year, but would lock you into your chosen plan for the entire year.
Let's fight this stealth attempt to undermine and privatize Medicare. It's time to acknowledge that private for-profit health insurance has been a costly failure that deprives millions of Americans of decent health care.
There is a rational and affordable alternative, which would establish a drug benefit plan within Medicare rather than in the private sector.
Ultimately, we must expand Medicare as a public, single-payer program that will provide medical coverage, drug benefits and long-term care to all Americans in a cost-effective, simple and equitable manner.
X Mary E. O'Brien is a member of the board of directors of New York Metro Physicians for a National Health Plan. The writer wrote this for Progressive Media Project, a source of liberal commentary on domestic and international issues; it is affiliated with The Progressive magazine. Distributed by Knight Ridder/Tribune Information Services