Unhappy with Medicare?

Published 2:55 pm Wednesday, December 6, 2006

By By Robert Goldberg
While the overwhelming majority of senior citizens are happy with their prescription drug coverage under Medicare Part D, some have realized that the plan they picked was not what they wanted or needed.
But seniors who fall into this category have good news: From now until Dec. 31, Medicare Part D will offer an "open-enrollment" period, meaning that recipients can change their prescription drug coverage to pick a new plan that better meets their needs.
Unhappy seniors should jump at this opportunity to switch. Many will discover that insurance providers listened to their complaints and are now offering even better plans than before. For example, several plans now cover the much talked about "doughnut hole," meaning that out-of-pocket costs have dropped significantly. Many others have lowered the co-pay for drugs. Finally, more plans have added many new medicines that were approved by the FDA as recently as last month.
All told, seniors will have more opportunity to lower their out of pocket drug costs and tailor their drug plans to their medical needs. So even seniors who are pleased with their drug coverage should examine their options.
Whether they want to sign up for the first time or change plans, seniors shouldn't delay. This open-enrollment period happens only once per year, from Nov. 15 through Dec. 31.
This enrollment period makes Part D different from traditional one-size-fits-all government health plans, where there are no options.
Just look at the prescription drug plan offered by the Department of Veterans Affairs, which lowers drug prices and reduces costs in three ways. First, by law, the VA can command below-market prices. Second, to reduce prices further, the VA limits the choice of drugs through a national formulary, which offers only 30 percent of the drugs available under Medicare. Finally, the VA delays and limits access to new medicines.
Every drug given "priority" status by the FDA since 1995 is available under Medicare Part D, but not on the VA formulary. For instance, there's a drug called Gleevec that is now first-line therapy against stomach cancer, one of the world's most painful diseases. But before the VA will dispense Gleevec to veterans, they first must try an older drug known for its harsh side effects. Only if patients fail on that medication can they use Gleevec.
The VA also automatically delays access to new drugs for a year, regardless of whether affected veterans will even live that long.
That's why those who are dependent on the VA system lead shorter lives and have access to few of the newest drugs.
The Medicare drug benefit takes the opposite approach. Rather than offing seniors a single price-controlled government plan, it leverages market forces to create competition, which leads to lower prices, better service and more choices. In fact, both Medicare and the Congressional Budget Office found that private competition offers the same savings as a government-run system with more choice and less bureaucracy.
Under Part D, private companies compete for the business of seniors. That's why three out of four seniors enrolled in the Medicare drug program are satisfied, and nearly three-fourths expect their drug costs to stay the same or decrease thanks to the plan. More than four in five seniors say they've had no problems getting their drugs. And because of the program, 20 million seniors who had no previous drug coverage are now insured.
In the coming weeks, seniors should take advantage of the open enrollment period and sign up, or switch to a new plan that better meets their needs. And they should pay attention to any effort Congress makes to take those choices away. Choice is what the new Medicare program – and better health – is all about.
Robert Goldberg is Vice President of The Center for Medicine in the Public Interest

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