Medicare Part D Plan -- Big Increases

chisueSeptember 21, 2011

We've received the 2012 Medicare Part D plans from our current insurer. Enrollment is Oct. 15 - Dec. 7.

The plan cost has increased 10%.

The amount we will pay towards our Tier 3 meds has increased 16%.

The amount DH will pay for his Tier 4 med has gone from 11% to 33%.

Who knows how much the actual retail on the meds will increase!

We only have three daily use prescription medications between us: Two are Tier 3; DH has an expensive Tier 4 med. He was in 'The Gap' by June 2011; he may be there by March at these rates!

I don't see any of our meds going off-patent anytime soon.

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Not a big surprise, surely? Bush's expansion of Medicare into Part D was forecasted that premiums were inadequate to cover costs, as I recall.

The Healthcare Reform bill was going to eventually eliminate the 'donut hole' within the next few years, but the Repubs have already stated that if they get control of the Senate in 2012, every effort will be made to repeal the bill.

After that I wouldn't be surprised to see them go after entitlement programs. They have never liked SocSec or Medicare.

Our patchwork healthcare system will continue to cost us more than it should, while providing less than optimal care, or none at all, for far too many. When the vast majority of healthcare companies are run for profit, what results are great advances, but at a high cost with no focus on the bigger picture.

There are no financial rewards at any level in our healthcare system for keeping people healthy. Everything is geared towards fixing things after something serious has gone wrong.

    Bookmark   September 21, 2011 at 1:24PM
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Chisue, have you looked at other plans? I believe there is a website where you may check the price of each of your meds on the different plans.

Here is a direct quote from the instructions for applying for "Extra Help." Extra help pays your Mediare premium for you.

"You may qualify if you have up to $16,245 in yearly income ($21,855 for a married couple) and up to $12,510 in resources ($25,010 for a married couple)."

Here is a link that might be useful:

    Bookmark   September 21, 2011 at 11:56PM
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"There are no financial rewards at any level in our healthcare system for keeping people healthy. Everything is geared towards fixing things after something serious has gone wrong."

I agree.

    Bookmark   September 22, 2011 at 12:53PM
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Doesn't the much-maligned "Obama-care" add coverage for annual physicals and other 'early discover' tests to Medicare? Hasn't coverage for children and young adults been expanded?

We don't qualify for aid, and that's OK, because we CAN afford this, and our Medicare Gap insurance has been 'group', via DH's former employer.

It galls me that prescription drug costs are uncontroled and that companies can *advertise* prescription drugs -- unlawful in every other country except New Zealand. Why do you supppose Adviar, on the market since 2002, went from $500/90-day supply in January 2011 to $800 in March? I'm sure you've seen their TV ads and gotten handouts from your pharmacist.

Our costs for Medicare Part B, Medigap coverage, Part D coverage, and the (discounted) drugs themselves is nearly $9K. Our dental bills so far this year are over $4K.

Nancy -- Thanks for the suggestion, but Medicare decides which drugs go into which 'Tiers'. That's where we'll be hit hardest for 2012. Each of our three drugs moved up a tier. DH will be in the coverage gap early, after which he pays 50% of his prescription retail costs. Yet, he won't reach the catastrophic stage, where he'd pay 5% (when out of pocket hits $4700).

Uncontroled drug costs are at the bottom of this. Retail for DH's two prescription meds is $8267/yr. Retail on mine is $3330/yr. We are paying more for medical and drugs than I budget for FOOD. And we are relatively HEALTHY!

    Bookmark   September 22, 2011 at 2:22PM
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Actually, it's a common misunderstanding that the new Reform bill pays for annual physicals. It pays for an annual WELLNESS exam, which is fairly perfunctory - but for those who only have catastrophic, is at least better than nothing, which is what they had before.

The trade-off in our increased life expectancy is that the cost of medications and procedures which push that longevity is a sizable bill that continues to rise.

It's why I've never been impressed by the arguments people make when they say, "Well, everyone in my family has always gone quickly", e.g., my MIL's standard claim. She doesn't understand that the recent huge jump in longevity means that people who died quickly/young before 1980, these days can be saved and given ever-increasing life expectancy.

And it's why there is more attention in the media when statistics are accumulating to show that a couple needs to have "$xxx,xxx.00" on average to pay for medical expenses that are not covered by Medicare, not including long-term-care costs.

People sometimes vastly overestimate what Medicare covers, because there are certain situations where it covers very little. With the current political situation where the special budget committee either compromises on where to cut $1.5 trillion from the budget or automatic cuts will be made to all programs in 2012, Medicare's average coverage of 51% of expenses will no doubt decline even lower in the future.

    Bookmark   September 22, 2011 at 3:04PM
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jkom -- Thanks for the information about 'wellness' exams v a full physical. It's still a screening many people would have gone without, IMO.

Correct me on this, please, because you have more information than I: Aren't medical expenses in the US heavily concentrated on measures to stave off inevitable death? I've read that futile interventions during the last three months of an elder's life account for most of that individual's medical expenses. These measures prolong death -- while adding to the time a hospital can profit from hugely expensive 'treatments'. (Save me from hospitalization as I die!)

    Bookmark   September 22, 2011 at 5:43PM
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>>Aren't medical expenses in the US heavily concentrated on measures to stave off inevitable death? >>

I've read several articles (must have been either AARP, NYTimes or WSJournal) that say that 80% of Medicare's budget is spent on 20% of insureds - the very frail and dying. But we should remember, this is true the world over. It's merely a question of who pays for it and for how long. Nobody anywhere wants to be the one who says to the family, "the plug has to be pulled because we're not going to pay for it any longer."

Now, the ridiculous claim of "Medicare Death Panels" has been thoroughly debunked already, so no need to go over that ground again. Factually, ALL insurance companies globally have a Chief Medical Examiner whose job it is to approve or disallow payment for expensive treatments. That's what they do - balancing medical guidelines, doctor preferences, patient coverage, and company profit (no, company profit is not always paramount; but is an important factor in overall portfolio risk management).

In the absence of clear, specific legal forms by the patient as to how end-of-life treatment is handled, the medical profession by its nature will do everything to save you from dying. Palliative care and pain management is only beginning to make an impact on their thinking, but again - without clear legal guidelines as to what the patient wants, ESPECIALLY if those instructions are contrary to what the family expresses - the doctors will do everything possible.

And these days, "everything possible" is usually expensive with little regards to the quality of life.

That's why it's absolutely critical to talk about what you want with not only your spouse, but your doctor and your family. Then put it in writing!

BTW, I should amend my posting about the 'wellness' exam of the Healthcare Reform Bill. The NYTimes did an absolutely wonderful, comprehensive piece on this subject - what is covered, what is not, and why some consumers are surprised when they receive a bill they didn't expect. We have to remember, a physical exam for a 16-yr-old is going to be different than that of a 50-yr-old, which is again different than the exam for a 70-yr-old with severe medical issues.

As it stands now, with the government gradually clarifying what is paid for and what is not, the two key things to note are: most of these don't begin until next year, and in areas where it's still 'gray' without legal definition, the insurers are allowed to make their own decisions about what is covered and what is not.

(Access to the NYTimes is limited to 20 free articles/mo.)
Preventing Sickness, With Plenty of Red Tape
NY TImes September 19, 2011

(Excerpt) "Prevention has never been the cornerstone of American medicine. In this country, we tend to go to the doctor only when something is wrong, a habit long bemoaned by researchers and medical groups.

The federal government aims to change that, and soon. Starting this year, insurers will be required under the Affordable Care Act to completely cover such services as annual physicals, childhood vaccinations and dozens of screening tests for everything from high blood pressure to abdominal aortic aneurysms.

Just last month, the Department of Health and Human Services released additional guidelines specifying fully covered preventive services for women. Mammograms, cervical cancer screening and other services already had been mandated; the new recommendations expand that list to include screenings for human papillomavirus (which causes cervical cancer) and domestic abuse, and reimbursement and counseling for contraceptives. These services are to be fully covered by most insurance plans beginning in August 2012.

Despite these new regulations, there's still a lot of ambiguity - and not just among consumers - about what qualifies as preventive care and what insurers are obligated to pay for. "I've seen so much confusion among patients and doctors alike trying to figure out what's paid for and what isn't," said Dr. John Santa, director of the Consumer Reports Health Ratings Center and a primary care doctor. "

Here is a link that might be useful: Full Article: Preventing Sickness

    Bookmark   September 23, 2011 at 12:02PM
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jkom -- THANK you! I know it isn't only profit that drives medical expenses, but after all, this is the US, where regulation of commerce is 'bad', and where most people don't see the 'commerce' of medicine. You're saying this is true the world over? I didn't think so.

My view of medicine as business was broadened by a MIL who had been an RN and hospital administrator in the 1930's. It hasn't changed much. A network of doctors still runs hospitals and clinics. They have eliminated non-profits that used to provide home health care and hospice care -- adding those sectors to a revolving door of profitable 'care'.

My mother was in hospital more than she was out during her final year (leukemia). This was before DRG's were mandated to prevent hospitals from milking Medicare by keeping their beds full. Hospitals adapted by getting into newly-profitable nursing homes and home health care.

Your MD orders MRI's, X-rays, tests at his clinic. He admits you to his hospital. You get more tests, surgery, whatever. You are referred to the network's nursing home or for home health care by that branch of the network. Back to the hospital. Rinse, repeat, unless you opt for hospice care -- another wing of the hospital-based network. They call it 'continuity of care'; it also serves to keep all the money 'in house'.

    Bookmark   September 23, 2011 at 6:10PM
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Yes, cost containment is an even bigger issue for countries with nationalized healthcare than it is in the US. France is facing major problems and several EU countries have changed or are contemplating changes to how the private insurance marketplace coordinates with government healthcare.

The 'graying of the populace" is a global phenomenon, definitely not limited to the US. China is in one of the worst positions of all: a rapidly growing population of elderly, fewer children/future workers under the 'one child' policy, and few government social programs to backstop the economy.

Chinese workers don't save 30% of their wages (on average) because they're naturally savers - they save it because they HAVE to. There is no one else to depend upon, and there is almost no economic 'safety net' or widely available healthcare for serious diseases as people age.

So many of the things we take for granted - good teeth, glasses for vision or surgery for cataracts, hearing aids for hearing loss, blood pressure medication for stroke victims or heart surgery for arteriosclerosis - are unavailable to all except for a modest percentage (the elite) in China.

One of the biggest surprises US retirees have when they emigrate to Central America or South America, is that for serious illnesses or operations, the recommended hospitals are in Cuba, courtesy of a good healthcare system originally set up by the Russians for Fidel Castro. Acting as the Southern Hemisphere's 'critical care of choice' has brought in a lot of $$$$ to the Cuban government over the years.

    Bookmark   September 24, 2011 at 4:27PM
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Wow! Fascinating about Cuba, and the Soviet origin of the health care system. That explains why South American dictators, er..duly elected officials...go to Cuba for care.

Save a third of income...gee, maybe I'm part Chinese! Or was, in another lifetime. Here I thought it was my Scots genes. lol

    Bookmark   September 26, 2011 at 1:22PM
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Costa Rica also has an excellant health care system which is completely free to residents. The government is able to fund this, and also other elements of a strong social safety net, such as universal free schooling through university, because it has no standing army or navy and very minimal military expenses.

Many Americans go there for dental care and even elective surgeries because they can get good care at much lower prices than in the US.

    Bookmark   September 27, 2011 at 2:09PM
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The strength of the cuban healthcare system certain isn't stemming from some russian plan to keep castro healthy. Yes, russia subsidized virtually everything in cuba during the cold war, but those subsidies ended 20 years ago.

After the revolution, about half of the doctors in all of cuba fled for the US. After that Che Guevara led a campaign to train thousands of new doctors and helped get healthcare rights added to their constitution. He was way ahead of his time in terms of promoting preventative medicine. Mostly those were all really low tech ideas - better sanitation, more checkups, across the board vaccinations etc According to the WHO, cuba spends only $251 per person on healthcare but they have the same life expectancy as we do spending $7,500.

It really is quite an amazing contrast. Cuba spends most of their heathcare dollars preventing disease and intervening early. In the US, we spend almost nothing to keep people healthy but pay through the nose to treat them once they get sick. There are ton of things wrong with Cuba, but they definitely have the right idea in terms of how to address healthcare.

    Bookmark   September 27, 2011 at 2:25PM
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