I thought I'd open the issue of "the elephant in the room."

It's a pressing issue for seniors starting with signups this month and continuing for 90 days.

Does ANYONE understand it?

What are your opinions of it?

How are seniors going to deal with the UNBELIEVABLE complexities of the thing?

How does it affect YOU?

If you are a senior and need help I would be happy to answer your questions.
If you are looking for discussion read your local newspaper. Either way, don't worry about it now. There will be some changes before enrollment ends in 2006. It just doesn't work, but it is better for some than nothing.

I thought I'd open the issue of "the elephant in the room."

It's a pressing issue for seniors starting with signups this month and continuing for 90 days.

Does ANYONE understand it?

What are your opinions of it?

How are seniors going to deal with the UNBELIEVABLE complexities of the thing?

How does it affect YOU?



First, let me say that I had great hopes for the Medicare prescription plan. Now, I see it for what it has become - the biggest ever rip off of seniors!!!

I've spent hundreds of hours reading and studying the materials from Medicare and the various policies being offered from the companies in our state. As a retired Federal Servant I am paying a huge amount for my insurnace but my mother has only Medicare and I find it totally reprehensible that our own government is willing to present this package as a help for seniors when it really rips the seniors off.

More than 60 companies are available to seniors on Medicare here in my state. We tried to get upgrade my mother under AARP insurance some months ago, but they refused to cover her even though we had until Dec 31 for her to be covered by a plan. It would not have been much help for her, but I felt it a better option than what I was studying under the early literature. Actually, for the high premium she would have paid, we might possibly have come close to breaking even in that the premiums and deductible plus what she would pay for her share of the meds after the deductible would be close to what we are pay for at 100% now, but I felt it was her best choice just in case she needed more meds in the future. Her meds are not near what mine cost. Still, she would have had to pay for the policy then pay the first $500 then 1/2 of the costs up to the gap area, but she would have been able to get the brand named meds, which is not really a choice with the Medigap plans.

Oh, yes, they indicate you can get the brand names, but once you study the fine print and look at the categories or classes of the meds, it is a whole other issue. Why? Well, first because the goverment did not place any controls on the pharaceutical companies and insurance companies who offer these plans, when I plug in her specific meds, she would wind up paying a premium in order to pay a LOT more for the meds we now pay 100% out of pocket, PLUS while a brand name is available (her doctors do NOT want her switching off hers because of heart valve replacement surgery and other problems), she would have to try the generics first and when they don't work (just how bad a reaction is one to have before they decide a generic or switching brands isn't working?) then after the doctor submits more justification she could get the brands. Okay, but then you look at how each company classifies each medicine, and with the tiers or classes they have used, the costs she would pay out of pocket is larger for these tiers/classes and what she pays totally out of pocket before the Medicare program even began!!! Therefore, she would be paying another premium through medicare to further reduce her limited income, in order to pay more for medicines, but first she has to get sicker by having a reaction because she is forced to switch to generics first!!!

So far, I have spoken at length with personnel in her doctor's office, and with at least 10 other individuals we know, who have also studied the plans at length. It seems that they have also come up with the same scenerio's and it looks like none of them will be taking the medigap medicine plan part D, either. Know that won't be the case with the majority of people, because actually, were it left to my mother, she could not possibly understand the materials I've studied, and sure could not have entered all her meds into the different drug coverages to see what the costs will be, much less consider the costs charts I've dealt with. Besides, you have all the type on TV and then companies phoning seniors and scaring some into believing that they HAVE TO sign up for a plan.

Is the plan worthwhile for anyone? Yes, for those individuals who could not afford any of their meds and income sufficiently low that the government will pay for their premiums. If they can come up with the 25% of the ridiculous amount that is going to be charged even for generics, then some will benefit because they will then be getting meds they might not have gotten in the past. Their total social security (after they add their $83 Medicare payment back into it) and other income if they have any, must not exceed $15050.40 per year. Sounds like a person might be able to make it okay, but then pull out the $996 the government takes back out for Medicare payments (and remember it goes up again in Jan), and what is left is not much to cover housing, utilities, food, gas if they can afford a car and insurance and clothing, especially with home heating being allowed to jump so much in the last two years.

What I've been wondering is whether the pharmaceutical companies will still help the individuals who had qualified in the past or will they force many of these same individuals to pay for premiums under the plan? Have read some of the steps involved in getting such assistance, and have to wonder if the doctors who already fill out tons of paperwork for such individuals to get help will be willing to continue doing that or will also implement a procedure to force their patients to cut out food in order to take one of the medigap plans?

I will see that my mother gets whatever medicines her doctor says that she needs, even if it means cutting something out of my strained income. But it does anger me that this is being played up as such a great thing and so very many are not capable of hashing though all the hype at this point, and won't get the point until they have those premiums further reducing their Social Security and get smacked with these higher prices that are being set for the meds. I just feel so sorry for them.

Oh, and how else are the insurance companies gaining from all of this? Well, last year my insurance under my Federal retirement went up 34% while my income went up 3%. This year the insurance is going up even more while my deductibles increase yet again.

I do hope that the program will benefit some seniors. But, at this point, from what I am hearing on the news, and discussions with others who are finding out exactly what I have found, it does not appear that this program will be of great benefit to the majority of seniors who are on Medicare. Thank goodness many already had medigap insurance which helped some with their medicines, and they can stay with that coverage.

Quietcook,

Is the plan worthwhile for anyone? Yes, for those individuals who could not afford any of their meds and income sufficiently low that the government will pay for their premiums. If they can come up with the 25% of the ridiculous amount that is going to be charged even for generics, then some will benefit because they will then be getting meds they might not have gotten in the past. Their total social security (after they add their $83 Medicare payment back into it) and other income if they have any, must not exceed $15050.40 per year. Sounds like a person might be able to make it okay, but then pull out the $996 the government takes back out for Medicare payments (and remember it goes up again in Jan), and what is left is not much to cover housing, utilities, food, gas if they can afford a car and insurance and clothing, especially with home heating being allowed to jump so much in the last two years.

There's an odious little provision that is NEVER mentioned that acts as an effective Catch-22 even for those with preposterously low income.
The catch is the ASSET TEST. If your income is a princely $500 a month (or even $200) and, as a single person, have $7,000 in assets you are deemed TOO RICH for the "emergency stipend." That $7,000 can even be in your VERY paltry IRA and put you into the TOO RICH category.

You really have to be several levels below DESTITUTE to get your premiums covered.

Yes, I'm aware of the asset limitation and she doesn't have assets to exclude her from assistance. She is a notch year baby so gets $150 less per month than individuals earning the same as she did all those years working on concrete in a factory. She didn't pay any less into social security, but gets less than those born only 27 days later just because of the year in which she was born. Although they didn't have birth certificates then, she would not say that she was born Jan 1, 1922, instead of Dec 1921.

Her income is so limited that she meets the assistance level, until they plus back in what she never sees - being the $83 or $88 for Medicare. When they do that, she is a few dollars over the poverty level, so does not qualify for any type of assistance whatsoever. Now, less than $14,000 a year as many can attest to, does not stretch far enough for medicines, groceries, heating, phone, taxes, and clothing, etc. Consider the many in this situation and then you can understand why even if they have a car, they can barely keep it running, much less carry auto insurance. She doesn't have a car, but dealing with her meds and this medicare plan has helped me understand a bit more why I must carry full insurance because my car has been hit so many times by individuals driving and struggling with near poverty level income, so they drive with no insurance in spite of a state law requiring that you have auto insurance. People try to lead as normal a life as possible on their income, and it becomes what is a must to survive.

In this case of the Medicare prescription plan being passed off as a help to seniors, in a way it is a blessing for many that it is so complicated. They are afraid to sign up and get the wrong thing, which may save them, because signing up will cost them more than just a premium, but can and often will mean that they will pay even more for the same medicines because of the lack of negotiations done with the companies, or in the case of those like my mother, they may be forced to a lesser medication that may not work for them, so they suffer the ill effects for whatever period of time until the company will pay for the right prescription. If that insurance company had to pay for the hospitalization or all the extra doctor visits, maybe things wouldn't be so ridiculous.

It is good that with some companies there will be a combination of benefits, and I'm glad that such events may help some. Spoke with a retired military today and apparently with this new plan Tri-care won't be available and he would be forced to use the Medicare prescription plan, get some other medigap insurance if he could or pay totally out of pocket for his meds. He had found that he would be better off not taking a plan, although I didn't get to find out if he had managed to get other medigap coverage or not.

Noticed tonight on the press releases, that only about 10% of the people who could subscribe have done so. If a low subscription rate holds true through the May deadline, will the program survive, or will the rates get jacked up really high? Guess we'll have to wait and see.

Going to put this topic to rest and enjoy Christmas events for the next few days. Merry Christmas to all.

My mom just got a letter from medicare saying the medicare in our state (NY) has picked up her $84 premium for medicare and she qualifies for part D. Her drug bill will only be $2.00 for brand name and $.50 generic. My mom also has Excellus bc/bs medicare plan as well. This pays her doctor visits.

I forgot to add, she owns a duplex and collects rent from her tenant. So I don't think the income is that low. :rolleyes:

My mom just got a letter from medicare saying the medicare in our state (NY) has picked up her $84 premium for medicare and she qualifies for part D. Her drug bill will only be $2.00 for brand name and $.50 generic. My mom also has Excellus bc/bs medicare plan as well. This pays her doctor visits.

I forgot to add, she owns a duplex and collects rent from her tenant. So I don't think the income is that low. :rolleyes:

She does not have to claim the value of the half of the duplex in which she lives, but I would not want to be in her shoes if she did not report the value of the other half of the duplex nor the income from that rent.

My mother has no such property and gets only $400 a month retirement, which has never increased since she retired in the 1980's. She gets $150 less per month than others who earned the same amount, simply because she was born the last month of the notch year babies. So, her little $400 retirement plus her social security is less than $14000 a year, but when you add back in the medicare premium she pays then it barely puts her over the $15050 poverty level so that she cannot get any help on the prescription plan premium, nor did she qualify for help on the 18 month prescription discount the government had. The point being though, if she kept a copy of her application, you might wish to review it.

You may wish to look at what she submitted to Medicare. She may have made an honest error in how she reported the value of the property or forgot to include the rent as income, but she should check it out by calling Medicare and at least asking to clarify her information so she can report her error, if she had made a mistake on her application. After all, the info requested can get confusing on what to include and not include. Applicants signed that what they were submitting was honest and acknowledged that they could be charged if submitting false information. Violating Federal laws can bring a lot worse penalties than state and local programs, and after a person is caught, confusion is not allowed as a defense. They forgive errors when the applicant reports correction, but can be really nasty when people receive and continue to receive benefits based on false information and make no effort to right the error.

My poor uncle lives in an adjoining state and he does qualify for assistance. He does own his land and a small trailer he lives in, which is not counted, but living on less than $6000 a year total income. It took lots of work but did manage to get him qualified for Medicaid. Hs doctors helped with lots of sample meds, but it is has really been impossible to get the various doctors to provide much help in getting his more expensive meds through the pharmceutical programs. However, his Medicaid has notified him of some additional help.

It sure can be complicated to maneuver through all the programs and applications.

Thank you for your information and research. I joined this group because I needed help understanding all this business about the Medicare Part D. I have to decide about my mom's plan and one for myself. I am so confused, and have felt like no one understands this either. Seems like our good government has given us seniors a "royal screwing" if you don't mind my saying so. Excuse me, but I try to tell it like it is. I probably won't sign up for anything and hope someone in the White House can fix it before next year. What a mess, and it is a disgrace. Just my opinion.

Qietcook, i didn't say how much rent my mom collects or how much her income is, so how did you get that she was cheating the system. My mom rents to her brother for a small amount, about $100 a month. He pays only if he has it to spare, it is not every month.

My mom is on ssd and she does file income taxes. Don't ***--ume that the "poor" doesn't pay their fair share, even if it is only pennies. She reported her income and still qualified.

Qietcook, i didn't say how much rent my mom collects or how much her income is, so how did you get that she was cheating the system. My mom rents to her brother for a small amount, about $100 a month. He pays only if he has it to spare, it is not every month.

My mom is on ssd and she does file income taxes. Don't ***--ume that the "poor" doesn't pay their fair share, even if it is only pennies. She reported her income and still qualified.

lane413,

Sorry if you misread what I said and thought I accused her of cheating the system. I most certainly did not. If she reported all her income and still qualified then good for her.

Another thing, I did NOT assume that the poor don't pay their fair share, because my family is part of the working poor, barely getting by just like many others. My mother stood on a concrete floor working in a factory for more than 50 years and still gets screwed by the government even today. Because her birthday is in December 1921, she gets $150 less per month SS income than someone making the same few dollars she brought home, but was born just a few days later.

I try not to make assumptions, but try to respond based on what an individual posts. Sorry you didn't read exactly what I responded.

Quietcook, I think I read your post exactly right. You mentioned in your post that (paraphrase) the govt. would forgive a mistake, but not confusion as an excuse. Well again, my mom did not like about anything. She took her documentation and all necessary paper to ssa to get assistance filling out the paperwork.

My mom isn't that old, she's just disabled. She is a volunteer with AARP and she goes to our community college, Im sure she got a lot of help and support from her law professors.

I'll let your comment go, but just don't assume everybody is double dipping. Your post was crystal clear to me. Good bye.

Lane,

This will be my last response, and again, I apologize to you that you feel slighted in any way. However, what you have chosen to ignore was that I also addressed the asset level which was addressed in the application process in order to qualify for assistance. While applicants did not have to claim their home, they did have to claim rental property as assets, and as you are speaking of a duplex versus a single home, then sure, the side that your mom lives in is her home and does not have to be claimed. However, the fact is, the whole duplex is not her home, so half of the value of the property was to have been claimed in the space which defined assets including such things as savings accounts, etc.

There was absolutely no accusation of her cheating, but if she did not claim half of the value of her duplex as an asset, and claimed it all as her home, then there is indeed an error in her application. If she did not report the income from the rent, even if it is only some months of the year, then that too is a big mistake. The government does counts it even if it is just some months!

I don't care how she filed her application. I do know of someone who made such a mistake and when they inquired about it, it did knock them off eligibility, because they had declared the whole piece of property as their home so had not listed any of its value as part of their assets. Their sister lived in the other side. As a poor widow who gets the very minimum SS & SSI, because she and her deceased husband had been share crop workers, she is unable to pay anything to her sister. They both are doing good just to stay afloat by receiving meals on wheels.

Sorry you chose to accuse instead of discuss.

I work in a medicare dedicated unit at an insurance company in NY, it is a very confusing plan, and took me about a month's worth of training before I fully understand the plan. It will help some people out better then before, and for others they will not see any help. Before medicare picked up Rx, the average senior was paying full price for Rx, and maybe with a little assistance from the insurance company they would get a discount. depending on if they were with original medicare or if they went with a private company.
for example in my area last year we had 3 plans that ranged in price from $0-$15-$68 month for medical coverage, the Rx that was covered was only generic, and the namebrand were discounted 15-30%, not many seniors are on generic, so they would still pay close to $130 and up for Rx, if they were on a lot. now the plans range from $0-$15-$45, and the last includes the part d, with Rx costing $5 for generic, $35 namebrand. now the drugs are only covered if they fall on the formulary drug list, and the lists are different from company to company, and HMO to a PPO plan. if the drug is not on the list, they can get a transition supply of the drug for 30 days, so they can find another drug on the list, or they need a letter from their dr. now you can call social security and ask for an application for Rx coverage, and it is based on income, (not sure how much) they can award you anywhere from 25-100% assistance, but it is only applied to the part d of the premium. so our product that is $45, with 100% subsidy is $22.90 is the member's monthly payment (unless they receive additional assistance from medicaid for that) the Rx are reduced to $1 and $3 or $2 and $5
in our state we also have a program called EPIC, its a Rx assistance drug program for seniors over 65, also based on income. if someone qualifies for EPIC, they are on a credible part d plan. you must pick up some sort of credible part d plan before May 15th to avoid the penalty. then there are people who are in group plans through their former employer, some of them were paying $250 a month for medical and Rx coverage last year. now the private pay plans are offering similiar coverage for less, so a lot of people are dropping the groups.
so you can go the route through a private insurance company, and would pay your part B premium to the gov't, and then your premium to the insurance company. which would be primary and handle all claims, nothing gets to medicare. or you can go with original medicare, and pick up a part d Rx plan only, and/or pick up a supplemental plan where medicare is primary, the supp picks up what medicare doesn't, but your paying $120-$270 per month. or find a drug assistance plan like EPIC to help the costs. but like I said before this plan will help some, but not all.
so hopefully this helps you some, and didn't confuse you more. if you have questions try calling a local insurance company that has customer service in medicare only, they may help you, or you can ask me!!