Medicare D: Confusion and Contradiction

The Detroit Free Press is today reporting that:

Leavitt said Medicare would notify the private drug plans administering the new Medicare drug benefit that they need to extend that emergency coverage for 60 more days.

“In effect, this means that plans will provide up to 90 days of coverage for a beneficiary’s current drugs,” HHS reports.

However, the additional supply of rx’s is, in theory, supposed to last a person until he/she completes the appeals process if the rx that their dr. prescribes is not covered under one of the formularies/plans.

continued

Mary Johnson, executive director for the Michigan Medicare Medicaid Assistance Program, said she has had difficulty verifying the status of drug appeals for patients.

Pharmacist Ibrahim Chami, owner of Detroit Pharmacy, said he expected that patients would experience problems with only 30 days to appeal. With the difficulty re: the status of the appeals, would an additional 60 days make that much of a difference?

Chami also stated,

“With my customers, I tried to explain it…But I know there are people out there that don’t have someone to explain it to them.”

In addition, the Center for Medicare Advocacy Inc. reports that many patients have had difficulty getting Medicare drug plans to fill the original 30-day prescriptions to begin with.

“Even when beneficiaries are able to secure a transitional supply of medications,” the center wrote in a weekly e-mail alert, “they are not being told that they must take further action to get their medications” (when the emergency supply runs out).

So, all a person can do is file an appeal, if he/she is aware of the appeals process to begin with, or, switch their rx’s and there may not be a (generic) equivilant that fulfills one’s medical need!

And, there is more:

Gov. George Pataki said Friday he was vetoing a bill that would have indefinitely given New Yorkers access to medications if they are denied coverage under the new Medicare prescription drug benefit…Pataki, a Republican, enacted a temporary measure Jan. 13 directing the state Health Department to allow access to the drugs for seniors eligible for Medicare and Medicaid. The legislation would have permanently extended the measure until problems with the Medicare benefit that launched Jan. 1 were completely resolved.

Still more:

Officials from California, Kentucky and other states say they are being asked to reimburse Medicare for more than they are saving…

California Attorney General Bill Lockyer said Wednesday that his state would join several others in a lawsuit to ask the Supreme Court to halt the payment requirement. Republican Gov. Arnold Schwarzenegger said he supports the expected suit.

Kentucky Attorney General Greg Stumbo said Thursday that the case will be filed by March 1.

His state will have to pay the federal government $20 million more a year than it previously spent on drugs for its Medicaid beneficiaries, he said.

Kathy Walt, a spokeswoman for Texas Gov. Rick Perry, said the state is considering a number of options, including a lawsuit.

Despite earlier claims re: lower drug costs, Rep. Henry Waxman, D-Calif., said,

Medicare officials had lost credibility. “They tell us that prices are amazingly low when seniors can see with their own eyes that that isn’t the case.”

According to Sen. Herb Kohl, D-Wis.,

basing multiyear estimates for a complex program on one month’s data was “ludicrous.”

Just say it, for crying out loud–MEDICARE D IS UNWORKABLE FOR THOSE WHO NEED IT MOST!

8 Comments

Street Kid on February 3, 2006 at 10:42 pm

xposted at dkos and mlw

Street Kid on February 4, 2006 at 2:37 am

missed this one

WASHINGTON – President Bush hopes to seize momentum from a just-completed budget cut bill by proposing tens of billions of dollars in savings from the Medicare program when he submits his 2007 budget on Monday.

The budget is expected to wring perhaps $40 billion over the next five years from Medicare providers like hospitals and home health care providers, as called for by the Medicare Payment Advisory Commission, a bipartisan panel of experts that makes Medicare policy recommendations to Congress.

Last year, Bush urged Congress to leave Medicare alone as the administration began implementing the new Medicare drug benefit. He instead focused on finding savings from the Medicaid health care program for the poor and disabled.

After Congress just squeezed $28 billion from Medicaid over the next decade _ considerably less than the $45 billion proposed by Bush a year ago _ the president is looking for big savings from the rapidly growing Medicare program, said lawmakers, staff aides and health industry lobbyists.looking for big savings from the rapidly growing Medicare program, said lawmakers, staff aides and health industry lobbyists.

Bush is expected to steer clear of proposals asking direct election-year sacrifices from Medicare beneficiaries, who are already agitated over foul-ups in the startup of the new prescription drug program.

But hospitals and other powerful interest groups are girding for battle over cuts they will be asked to take. Adopting the Medicare Payment Advisory Commission’s recommendations would give the White House political cover for Bush’s new proposals.

The commission recommended reducing payments to hospitals for both inpatient and outpatient care by about half of 1 percent below scheduled inflation adjustments.

Home health care providers under Medicare fear seeing their payments frozen as recommended by MedPAC. The advisory commission also has recommended freezing payments to nursing homes and long-term care facilities.

“It’s doable and it’s good health care policy,” Senate Budget Committee Chairman Judd Gregg, R-N.H., said of the MedPAC recommendations. Gregg said he expects significant Medicare cost curbs to be included in Bush’s budget.

chocolate ink on February 4, 2006 at 12:47 pm

I was just reading this last night….glad you posted article. I guess if they can’t get rid of Social Security like they have wanted to for a long time they are going after Medicare. Why should the repugs worry-they don’t need SS or Medicare thanks to the taxpayers…their retirement and medical plans are more than fucken adequate.

Saving money and being fiscally responsible(ha) was never their intention..if it was instead of trying to screw Medicare they’d listen to the IRS when that agencey has stated that they have 300 yes 300 fucken BILLION dollars in taxes that they can’t collect from rich people and corporations because they don’t have enough people to pursue collecting those taxes. Although they were given money to go after poor people in case they happened to be cheating..yeah someone who makes 15,000 a year has to be audited right..
- Street Kid on February 4, 2006 at 4:45 pm
  
  being fiscally responsible(ha) was never their intention..if it was instead of trying to screw Medicare they’d listen to the IRS when that agencey has stated that they have 300 yes 300 fucken BILLION dollars in taxes that they can’t collect from rich people and corporations because they don’t have enough people to pursue collecting those taxes.
  
  That would definitely finance a single payer health care system.
  
  By any chance, do you have a link? (You are so good at that!)
  - chocolate ink on February 4, 2006 at 11:09 pm
    
    Yes I do somewhere…let me go look..
    - chocolate ink on February 4, 2006 at 11:30 pm
      
      http://www.oneamericacommittee.com/ This isn’t a link to the article but it is a link to sign John Edwards petition on this very issue. He states that bush has basically declared war on poor people..and mentions the 300 Billion a YEAR that is not being paid…pretty dam disgusting isn’t it. Rethugs are running around basically cutting all social programs saying they need to fiscally responsible..yeah right when this 300 fucken BILLION alone would more than solve the problem…then if you add in all the pork barrel bullshit I think that’s another 20 or more BILLION-enough to make you want to cry.
      
      If you want an article also I will look it up.
      
      About your PS below…I hadn’t thought of that..that if you weren’t on disability but I think that the only way you can get on Medicare if you are under the age limit is to be disabled. I don’t know that for sure though that’s just my thought off the top of my head.
    - Street Kid on February 5, 2006 at 2:33 am
      
      That’s ok. The link that you gave me was enough. And that is what I thought about the Medi-Cal. Thanks again!
Street Kid on February 4, 2006 at 5:05 pm

By any chance, do you know the answer to this:

Of dual eligibility Medicare/MediCal recipients, when can one be below retirement age?

Is it only if the person has been found to have a disability under SSD/I?

Street Kid on February 3, 2006 at 10:42 pm

xposted at dkos and mlw
Street Kid on February 4, 2006 at 2:37 am

missed this one

WASHINGTON – President Bush hopes to seize momentum from a just-completed budget cut bill by proposing tens of billions of dollars in savings from the Medicare program when he submits his 2007 budget on Monday.

The budget is expected to wring perhaps $40 billion over the next five years from Medicare providers like hospitals and home health care providers, as called for by the Medicare Payment Advisory Commission, a bipartisan panel of experts that makes Medicare policy recommendations to Congress.

Last year, Bush urged Congress to leave Medicare alone as the administration began implementing the new Medicare drug benefit. He instead focused on finding savings from the Medicaid health care program for the poor and disabled.

After Congress just squeezed $28 billion from Medicaid over the next decade _ considerably less than the $45 billion proposed by Bush a year ago _ the president is looking for big savings from the rapidly growing Medicare program, said lawmakers, staff aides and health industry lobbyists.looking for big savings from the rapidly growing Medicare program, said lawmakers, staff aides and health industry lobbyists.

Bush is expected to steer clear of proposals asking direct election-year sacrifices from Medicare beneficiaries, who are already agitated over foul-ups in the startup of the new prescription drug program.

But hospitals and other powerful interest groups are girding for battle over cuts they will be asked to take. Adopting the Medicare Payment Advisory Commission’s recommendations would give the White House political cover for Bush’s new proposals.

The commission recommended reducing payments to hospitals for both inpatient and outpatient care by about half of 1 percent below scheduled inflation adjustments.

Home health care providers under Medicare fear seeing their payments frozen as recommended by MedPAC. The advisory commission also has recommended freezing payments to nursing homes and long-term care facilities.

“It’s doable and it’s good health care policy,” Senate Budget Committee Chairman Judd Gregg, R-N.H., said of the MedPAC recommendations. Gregg said he expects significant Medicare cost curbs to be included in Bush’s budget.
- chocolate ink on February 4, 2006 at 12:47 pm
  
  I was just reading this last night….glad you posted article. I guess if they can’t get rid of Social Security like they have wanted to for a long time they are going after Medicare. Why should the repugs worry-they don’t need SS or Medicare thanks to the taxpayers…their retirement and medical plans are more than fucken adequate.
  
  Saving money and being fiscally responsible(ha) was never their intention..if it was instead of trying to screw Medicare they’d listen to the IRS when that agencey has stated that they have 300 yes 300 fucken BILLION dollars in taxes that they can’t collect from rich people and corporations because they don’t have enough people to pursue collecting those taxes. Although they were given money to go after poor people in case they happened to be cheating..yeah someone who makes 15,000 a year has to be audited right..
  - Street Kid on February 4, 2006 at 4:45 pm
    
    being fiscally responsible(ha) was never their intention..if it was instead of trying to screw Medicare they’d listen to the IRS when that agencey has stated that they have 300 yes 300 fucken BILLION dollars in taxes that they can’t collect from rich people and corporations because they don’t have enough people to pursue collecting those taxes.
    
    That would definitely finance a single payer health care system.
    
    By any chance, do you have a link? (You are so good at that!)
    - chocolate ink on February 4, 2006 at 11:09 pm
      
      Yes I do somewhere…let me go look..
      - chocolate ink on February 4, 2006 at 11:30 pm
        
        http://www.oneamericacommittee.com/ This isn’t a link to the article but it is a link to sign John Edwards petition on this very issue. He states that bush has basically declared war on poor people..and mentions the 300 Billion a YEAR that is not being paid…pretty dam disgusting isn’t it. Rethugs are running around basically cutting all social programs saying they need to fiscally responsible..yeah right when this 300 fucken BILLION alone would more than solve the problem…then if you add in all the pork barrel bullshit I think that’s another 20 or more BILLION-enough to make you want to cry.
        
        If you want an article also I will look it up.
        
        About your PS below…I hadn’t thought of that..that if you weren’t on disability but I think that the only way you can get on Medicare if you are under the age limit is to be disabled. I don’t know that for sure though that’s just my thought off the top of my head.
      - Street Kid on February 5, 2006 at 2:33 am
        
        That’s ok. The link that you gave me was enough. And that is what I thought about the Medi-Cal. Thanks again!
- Street Kid on February 4, 2006 at 5:05 pm
  
  By any chance, do you know the answer to this:
  
  Of dual eligibility Medicare/MediCal recipients, when can one be below retirement age?
  
  Is it only if the person has been found to have a disability under SSD/I?

Medicare D: Confusion and Contradiction

About The Author

Street Kid

8 Comments

Recent Posts

Recent Comments