Caregiving: Medicare Part D

For 11 months now I have spent on average at least a  ‘working day’ a week battling to keep Patti’s private prescription insurance vs Medicare Part D. 

 

There is no more formidable foe than massive confused government bureaucracy. Your opponent is well staffed, well rested (they work “business hours” and field exactly one call or problem at a time) and knows only that the more paperwork pushed the better a job performance will be rated. “Care” is nowhere in their process.

 

Implementation of Medicare Part D is also impaired because it is the much ballyhooed social agenda of the Bush administration. Too many spin doctors and too few competent administrators are left in charge.

 

In a recent study Families USA forecasted problems will only increase next year.

Coverage through the "Doughnut Hole"

Grows Scarcer in 2007

    “… Unlike most forms of insurance, the Medicare Part D prescription drug program has a hole in its middle. This coverage gap, colloquially known as the “doughnut hole,” is perhaps the most bizarre and troublesome aspect of the Part D drug program.

     After beneficiaries reach their initial limit of total drug expenses ($2,250 in 2006), they have no prescription drug coverage until their total drug expenses reach a catastrophic threshold for the year ($5,100 in 2006). While beneficiaries are in the doughnut hole, they must continue to pay their monthly premiums, although they do not receive any drug benefits. Only after they have spent thousands of dollars of their own money to get out of the hole ($2,850 in 2006), in addition to their monthly premiums, does their coverage resume.

     The doughnut hole makes little sense from a medical perspective, as it financially penalizes sicker individuals who have more substantial drug needs. It has also generated considerable anxiety among seniors and people with disabilities in Medicare, who fear falling into the doughnut hole and being unable to afford their prescriptions. …”

 

For Patti, ONLY with her private prescription plan does she retain a hope of a return to homecare and most importantly affordable access to Multiple Sclerosis specific medications.