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News :: Politics : Social Welfare
More MEDICARE Health Care Myths: "Prescription Drug Plan Good"
08 Dec 2007
Do Legislators REALLY comprehend the Medicare program?

The Medicare Prescription Drug Plan: Is it working?
I am responding to Texas Congressman Joe Barton's editorial on the Medicare Prescription Drug Plan. Apparently, Barton is another legislator who is only mildly aware of the program's reality and how it affects recipients.

First of all, you must be a Medicare recipient to apply for the Prescription Drug Plan. That being stated, most of those on Medicare are on fixed income; consequently, few can afford the additional costs of another government health (Rx) plan. Also don't forget that Medicare does NOT pay for all medical, hospital and other related expenses.

Generally, it is a smart move for Medicare recipients also to acquire a Supplemental Health Plan coverage, one like the one provided by AARP.

However, when you're talking about eligible recipients paying for the Medicare Plan coverage, Supplemental Health Care coverage and then also Medicare Prescription Drug Plan coverage that must be paid as out-of-pocket expenses, how much do you think people over 65 and/or Disabled on fixed income are left with to pay for other living expenses? Not much, if anything!

The government does provide assistance for many of those on fixed income who earn up to a certain amount, which is based on the number of family members and the gross annual income of the family.

The government's assistance provides $38 per month for those applicants who are accepted. The problem is that most Medicare Prescription Drug Plans will charge more than that to provide the needed coverage. In other words, even those who get government assistance to become members of the plan will have to pay an out-of-pocket premium expense that most cannot afford.

In addition, drug plans do NOT cover ALL prescription medications so prospective applicants must be VERY careful to be certain that their prescription drugs ARE covered.

Furthermore, just because a provider does currently cover the specific prescription drug does NOT mean that the plan will continue to cover it in 6 months.

In fact, providers are notorious for eliminating various drugs from their plans and/or they may reduce the quantity allowed during the year. If this occurs, plan members will have more out-of-pocket expense that they cannot afford. Consequently, those who are covered must review their policy EVERY 6 months to ensure that no change has been made by the provider. And exactly how many Medicare recipients who are over 65 years old and/or who are Disabled can do that consistently?

There's yet another issue re: the Medicare Prescription Drug Plan. God forbid a member of the plan needs a "high-end" prescription drug every month (e.g., certain heart medication) for each year that falls into the category of a non-covered drug. What happens then is that there is an additional expense for the covered member that could be quite expensive.

While I'm in agreement with Congressman Barton that the Medicare Prescription Drug Plan is a good idea on paper and it is definitely needed by Medicare recipients, there are MANY changes that are needed to the program before it is truly deemed a successful program. Currently, the plan helps many yet also does NOT help many recipients.

Like so many of our elected officials, the congressman, as well as most of the public does NOT have all the facts regarding Medicare in general, and specifically the Medicare Prescription Drug Plan.

Peter Stern


Medicare drug benefit
Posted: Friday, December 7, 2007 11:35 AM CST

The calendar during November and December tends to get a little full. Between Thanksgiving, Christmas and all the festivities in between, often we have more to do than we have time. But one calendar item is essential for any Medicare-eligible senior age 65 and over, the open enrollment season for the Medicare Prescription Drug Benefit.

Running Nov. 15 through Dec. 31, open enrollment allows Medicare recipients to sign up for a prescription drug plan or change their current plan if they so desire. Like the Medicare Prescription Drug Benefit (also known as Medicare Part D), participating in open enrollment season is completely voluntary. Seniors who are happy with the drug coverage they receive from a private plan, or who aren’t interested in signing up for Medicare’s drug benefit by no means have to, and seniors who do have Medicare drug coverage and don’t want to change plans do not need to do anything to continue receiving their coverage.

It isn’t often that a program created by the government receives a satisfaction rating of 86 percent, yet that is the rating given by participants to the Medicare Prescription Drug Benefit. Then again, this benefit is not your typical government program. Created just a few short years ago and available for the first time in 2005, the Medicare Prescription Drug Benefit helps put life-saving drugs right in seniors’ medicine cabinets.

The broad success of this program is due, in part, to the vast array of options available to seniors. Rather than have the government dictate to seniors what plan they must use, the prescription drug benefit allows seniors to pick a program that fits their personal health and financial needs. Right now, Texas seniors can choose from one of 56 plans during the open enrollment period.

Another factor contributing to the success of the prescription drug benefit is the cost of the plans. These costs have been consistently lower than expected because rather than have the government set the price for each plan, the groups offering the plans compete with each other to provide seniors with the best value. This, in turn, drives prices down. According to the Department of Health and Human Services, 99.7 percent of Texas seniors on Medicare who are enrolled in a prescription drug plan can switch to a plan in 2008 that has premiums lower than they are paying right now. The national average monthly premium for a basic plan is projected to be $25 in 2008, far below the $41 average once predicted. While plans with the lowest monthly premiums may seem appealing, it’s important to take a close look at available plans and select the one that best fits an individual’s needs. Plans vary in cost based on a variety of factors, including type of drugs covered, deductibles and prescription co-payment costs.

Picking a plan can seem daunting, which is why the Centers for Medicare and Medicaid Services has set up a Web site,, and hotline, 1-800-MEDICARE, to assist seniors in comparing plans and selecting the one that is right for them. When using these resources, it’s important to have a list of the medications the senior is taking handy, as it will help determine what plan is right for them. Additional assistance is also available to low-income seniors, so it’s important that these seniors understand the options available to them.

At the conclusion of last year’s open enrollment period, more than 1.4 million Americans had enrolled in the prescription drug benefit. If you or a loved one are eligible and don’t currently have prescription drug coverage or wish to change the coverage you currently have, mark your calendar: Dec. 31, is the last day of open-enrollment. And just like Christmas shopping, it’s best not to wait until the last minute.

U.S. Rep. Joe Barton, R-Ennis, represents the Sixth Congressional District of Texas.


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