Asclepios
Forgotten People with Medicare
June 4, 2009 • Volume 9, Issue 22
One in four people with Medicare spend nearly a third of their household income on health care.
One quarter of people in the Medicare Part D drug benefit who are not enrolled in the Extra Help program fall into the “doughnut hole,” or coverage gap. Only 4 percent get out.
About ninety percent of people with disabilities are in poor health during the two years they wait for Medicare coverage to begin, but more than one in five has no health insurance.
Allentown, PA
Last month my husband and I received a letter from the County Assistance Office stating that our joint Social Security income was $40.00 too high to continue to qualify for the State Medicare Savings Program. OUCH! We are having a tough enough time now living on our Social Security income, but this makes it even worse. Beginning in June our joint income will be cut almost $200 because we will have to start paying Part B premiums. My husband has had several conversations with staff at the County Assistance Office and their response was only “We've gotten lots of calls like yours, but there is nothing we can do.”
(Submitted May 27, 2009)
Laingsburg, MI
I am a disabled individual who has Part D. I have been in the doughnut hole since March 5, 2009. I receive around $11,000 a year though Social Security Disability Insurance. I still have about $5,000 on my credit card from last year’s medications which I had to pay full price for during the doughnut hole. I can not afford to do this. I will not get the medication I need because I can not afford to pay full price. I take around 25 pills a day. That is 18 prescriptions a month, including 6 prescriptions that do not have a generic version. I have filled out the paperwork to get Extra Help and I was turned down. I have worked my whole life and to ask for help is not in my nature. I feel like I am begging for help.
(Submitted May 30, 2009)
Brookfield, MO
I have been on Social Security Disability for 14 months so far without medical care or medication while I wait for Medicare to begin. How can one be declared disabled and not need medical treatment? How can our disability be stabilized or even improved with no medical care for two years? I applied for Medicaid but can not meet the $1084.00 spend down per month. This program does not take into consideration that I have rent, utilities, food and other expenses. It only goes by my monthly Social Security Disability total amount of $1884.00 per month. There is no consideration of normal monthly living expenses.
I have had no medical treatment or medication for 14 months. I also have high blood pressure and glaucoma. Both of which should not go untreated. After having to be on Social Security Disability I’ve had to file bankruptcy and have lost my home, my automobile, auctioned off all my possessions that I have worked the past thirty years to be able to own.
What does it take to get medical coverage? Evidently being disabled is not enough.
(Submitted May 1, 2009)
As Congress tackles health reform this year, legislators need to remember people with Medicare, and the difficulties they face affording health care. Older adults and people with disabilities should not be denied medical treatment or medicine because they cannot afford them. Please write your elected representatives and remind them to Remember Medicare.
Medical Record
“Out-of-pocket health care spending imposes a financial burden on many Medicare beneficiaries, particularly those in poor health, with modest incomes, and at older ages. Over time, the financial burden of health care has grown among Medicare beneficiaries, as health care costs have increased more rapidly than income.” (Health Care on a Budget: An Analysis of Spending by Medicare Households, Kaiser Family Foundation, February 2009)
“From a health outcomes perspective, our finding that some enrollees stopped taking their medications or reduced medication use when they reached the coverage gap could be a serious concern. Individuals with diabetes, for example, risk immediate and potentially serious health consequences if they stop taking their medications.”(The Medicare Part D Coverage Gap: Costs and Consequences in 2007, Kaiser Family Foundation, August 2008)
“According to congressional committee reports on the 1972 legislation, the original purposes of the waiting period were to keep program costs down, avoid overlapping with private insurance, and ensure that Medicare coverage would be available only to those whose disabilities are truly severe and long-lasting. . . . With health reform and universal coverage prime topics of current policy discussions, ending the Medicare waiting period may become a moot issue. However, even universal coverage provisions may require that existing public programs maintain responsibility for the populations they now serve. One way or another, the policy that has been left in place for 37 years—and which today puts nearly 2 million people in limbo—should not be allowed to continue.” (The Long Wait: The Impact of Delaying Medicare Coverage for People with Disabilities, The Commonwealth Fund, May 2009)
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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.
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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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