Asclepios
Is Your Health Care Affordable?
October 29, 2009 • Volume 9, Issue 43
When Congress set out to reform the way Americans get health care, their focus was on guaranteeing access to affordable care for everyone. Both the House and Senate proposals provide subsidies for individuals and small groups to purchase insurance policies regardless of pre-existing conditions, and both expand Medicaid to more limited-income individuals.
It is the details in these proposals, however, that will determine whether the coverage options will in fact be affordable enough for people to access the care they need. If the combination of premiums, deductibles and copayments are beyond the means of low- and moderate-income Americans, many more may be covered but out-of-pocket costs could still be a barrier to health care.
That situation is all too familiar to many Americans. Surveys show there are 25 million people with health insurance that doesn’t provide them with adequate financial protection against high medical bills. More than half of these underinsured individuals go without needed care because of the cost.
The rate of underinsured is growing fastest among middle-income Americans. They include people with disabilities who have difficulty affording the high premiums and deductibles for COBRA insurance from their former employers as they struggle to survive the two-year wait for Medicare coverage to begin. They also include people with Medicare who split pills and skip doses after they hit the coverage gap—the infamous “doughnut hole”—in the Medicare drug benefit.
Congress needs to hear from their constituents who find the cost of health care—with or without insurance—is so high that they cannot afford the care they need. Share your story with us. If high copayments or out-of-pocket costs have forced you to forgo treatments, we want to hear from you. Please provide us with details about your situation, including your condition, and what types of care you had to sacrifice due to unaffordable costs.
With your stories, the Medicare Rights Center can reach out to Congress and to reporters, and work to reveal the hardships experienced by ordinary Americans. We will not use your name for any publication without your permission. If the goal of health care reform is to expand access to affordable insurance, we need to remind Congress what “affordable” means to people like you.
Medical Record
“One critical regulation is strong minimum coverage standards for health insurance sold over the exchange. This standard must mandate coverage for the wide range of services and products that are needed for effective treatment of illness and injury. Another key reform is to establish minimum criteria to ensure both affordability of coverage and adequate financial protection against the potentially catastrophic costs of medical care. To be equitable, the standards for affordability and financial protection must work for everyone, including individuals who have limited incomes or who need high-cost treatment.” (Role Models and Cautionary Tales: Three Health Insurance Programs Demonstrate How Standardized Health Benefits Protect Consumers, Medicare Rights Center, July 2009)
“Lack of adequate insurance coverage, the study finds, is not a problem limited to low-income people. Adults with incomes below the poverty level were at the highest risk of being uninsured or underinsured, but ‘insurance erosion has spread up the income distribution well into the middle-income range,’ the authors say. For those with annual incomes of $40,000 to $59,000, the underinsured percentage rate reached double digits in 2007. Barely half of those with incomes of 200 percent to 299 percent of the poverty level were insured all year with adequate coverage.” (How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007, Commonwealth Fund, June 2008)
“I have a Medicare Advantage Prescription Drug Plan and have already fallen into the doughnut hole. We haven't even finished up with the first quarter of the year 2009. My drug now costs me over $800.00 for a 30-day supply. It is an antibiotic that has no generic or competitors. So now I have to use my credit card and pay over 15% interest on the drug plus my monthly Medicare Advantage plan premiums, which provide no coverage during this time. I will have to take this drug for the rest of my life or until my credit card is maxed out; whichever happens first.” (Tell Us Your Story, Consumer from Aurora, CO, 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.
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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.