Asclepios
Don't Forget People with Medicare
May 14, 2009 • Volume 9, Issue 19
Congress has focused its health care reform efforts on providing affordable coverage to the 46 million uninsured in this country. When Medicare enters the discussion, it is principally as a mechanism for improving the quality and efficiency of our health care delivery system
Little attention has been paid to the gaps in coverage and high cost-sharing that make it difficult for people with Medicare to afford the medical care and prescription drugs they need. High-quality, affordable health care for older adults and people with disabilities should be front and center in health care reform.
Here are the steps Congress must take:
- Improve access to Medicare Savings Programs and Extra Help, programs that help people with limited incomes pay for Medicare-related costs;
- Eliminate the two-year waiting period for Medicare for people with disabilities;
- Create a drug benefit under Original Medicare.
People with Medicare should not be denied medical coverage or medicine because they cannot afford them. Currently, Extra Help, which provides coverage through the Part D doughnut hole and helps pay premiums and copayments, is available only to individuals earning less than $1,354 with limited assets. Help paying the Part B premium under the Medicare Savings Programs is even more restricted; individuals must earn less than $1,240 and the maximum in allowable assets is even lower than that for Extra Help. A more reasonable income ceiling for these programs would be set at 200 percent of the poverty line—a monthly income of $1,805 for an individual—and people on limited incomes should be allowed a modest nest egg for their retirement.
People with disabilities currently are denied access to Medicare coverage for twenty-four months after their Social Security Disability Insurance begins. The two-year waiting period exposes millions to financial hardship, pain and suffering. As many as one-third of those in the waiting period may be uninsured or have inadequate insurance coverage. Many forgo medical treatment or stop taking medications, compromising their already fragile health and resulting ultimately in conditions that are often more costly to treat when Medicare coverage finally begins. This unjust policy should be eliminated as part of health care reform.
People with Medicare deserve stable, affordable prescription drug coverage that grants access to medicines they require as their health care needs change. Under Part D, the list of covered drugs and coverage rules vary widely among the private drug plans, and many people with Medicare have experienced problems obtaining coverage for their prescriptions. No plan guarantees stable coverage from year to year. A drug plan administered directly by Medicare, with lower prices negotiated by the federal government, would provide a more stable, affordable and less complicated coverage option to older adults and people with disabilities.
Please write your senators and representatives and tell them to remember people with Medicare as they work toward reforming our health care system.
Medical Record
“Among Part D enrollees who filled one or more prescriptions but did not receive low-income subsidies in 2007, one quarter (26 percent) had spending high enough to reach the coverage gap. Fifteen percent of these Part D enrollees who reached the coverage gap ultimately had spending high enough to reach catastrophic coverage.” (The Medicare Part D Coverage Gap: Costs and Consequences in 2007, Kaiser Family Foundation, August 2008)
“Although our estimates indicate that the cost of eliminating the waiting period would be substantial, those costs need to be weighed against important potential benefits. First, fewer beneficiaries would delay or forgo needed health care because of out-of-pocket cost. Medicare coverage during the waiting period would allow a large number of individuals to obtain needed health care that they might forgo under current policy, at a time when their needs are quite substantial. Second, elimination of the waiting period would reduce the financial hardships experienced by individuals and their families who must pay high out-of-pocket costs for medical care due to lack of insurance, including those with high COBRA premiums.” (Costs and Benefits of Eliminating the Medicare Waiting Period for SSDI Beneficiaries, Mathematica, March 2009)
“The unprecedented privatization of a public insurance function embedded in the Medicare Part D program provides an excellent opportunity to understand how well individuals handle choice in their public insurance options. The…answer is “not very well” in terms of maximizing savings to the consumer; most seniors in this analysis did not choose the lowest-cost Part D plan available to them in 2006.” (Choosing a Medicare Part D Plan: Are Medicare Beneficiaries Choosing Low-Cost Plans?, Kaiser Family Foundation, March 2009)
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Medicare Part D Appeals Help for Advocates Is Here!
Medicare Rights Center’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
Register for a FREE copy of this great resource.
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Medicare Part D Monitoring Project
The Medicare Rights Center would like to hear about your experience, or that of someone you know, enrolled in a private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.
Submit your story at http://www.medicarerights.org/issues-actions/tell-your-story.php.
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The Louder Our Voice, the Stronger Our Message
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
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Get answers to your Medicare questions from Medicare Interactive at http://www.medicareinteractive.org.