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D Is for Dazed
By Jane Gross, The New York
Times
July 13, 2012
Photo Credit: Getty Images
Why
would anyone in her right mind spend July 4 — and then
July 5 and July 6 — trying to make sense out of
Medicare Part D, the drug plan added six years ago to
an otherwise user-friendly health care system widely
beloved by the 65-and-over set?
My 65th birthday is approaching, and with it the
deadlines for enrolling in Medicare. As a retiree, I
must switch my primary health coverage to its new role
as secondary provider to the government program. I’d
been writing about the elderly for years, had cared
for my mother through the last four years of her life,
was Dear Abby on this subject to my friends on a daily
basis. I thought I had it all down cold.
Only Part D scared me, because my mother died before
its advent and I had no experience helping someone
else with this. And I recalled, vividly, a recent
article by a colleague at The Times, Gina Kolata, just
before the new program took effect, when she assumed
the task of choosing the best plan for her aged
father. Ms. Kolata is a science writer and a whiz with
numbers, which I’m not — and still she was still
flummoxed by what Medicare purported to be a simple
online calculator for choosing a drug plan.
What she was looking for — what we are all looking for
— is one whose formulary best matches the list of
medications we take, and their doses, and the
pharmacies at which we obtain them, and even the
number of pills we must pop. It’s like solving a
Chinese tangram: Each time one puzzle piece doesn’t
fit, it’s back to square one.
Enrolling in Medicare Parts A and B was a snap. One
phone call, and within days I had my very own Medicare
card, ready for Sept. 1, the start of the month of my
65th birthday. The euphoria of that first phone call
gave way to some additional questions about cost. Part
A (hospitalization) is free after a lifetime of
Medicare taxes. The cost of Part B (doctors fees,
tests, equipment, etc.) depends on one’s adjusted
gross income and tax-exempt interest income. I called
my accountant to check on the first, my investment guy
the second. My cost would be $99.90 a month. Four
calls, all to real people, and done.
Next, I had to arrange the switch from my retiree
health plan, which would become secondary coverage
once I was eligible for Medicare. Now, $308.90 is
deducted from my monthly pension check for health
care. As of Sept. 1, that will drop to $48.49, as
Medicare will be responsible for most of my needs and
will bill me for my share of it. All of this happens
seamlessly, or so everyone promised. Until shown
otherwise, I believe them.
I shunned Part D until I was about out of time. My
mailbox was full of daily solicitations to buy this
drug plan or that. I kept all the brochures in a
folder until it got so fat it exploded onto my office
floor, all but burying me. There were phone calls from
agents, who said all their fees came from the
insurers; still, in their infinite generosity they had
figured out exactly which plan was right for me.
This legion of snake-oil salesmen did not exist when
Part D was new, and maybe Ms. Kolata would not have
been further confused by their barrage. But one look
at the Medicare Web site made me sweat. So I took the
coward’s way out and let one of the sales guys wax on
about the virtues of his plan until, ready to sign,
the reporter in me came alive.
Again I called Medicare. The monthly premium he had
quoted me was wrong, as was the plan’s formulary. He
never even mentioned that the plan covered only
certain dosages per pill and certain numbers of pills
a month. OMG, as one might say, if one weren’t almost
65.
Saved from myself, I called SHIP, the State Health
Insurance Assistance Program. After punching in my ZIP
code, I was connected to a counselor in the local
aging office. A county employee had me spell the names
of the drugs I take, and the quantity and frequency of
each. She asked my preferred pharmacy. Patiently
searching the database, she found three plans that
covered all my drugs.
They cost $95 to $109 a month (more than twice what
the soliciting agent had quoted), and one had a $300
deductible. But all included the most expensive drug I
took, which seemed to warrant their price tag. Still,
all three limited one of my medications to one tablet
a day; I now take four.
So I put SHIP on hold and called my pharmacist. He
said I should ask about formularies with 100-milligram
tablets rather than 50-milligram tablets, and instead
should take two a day instead of four. He also told me
that I should look for a formulary that excluded
another drug I took that I could buy over the counter
for only $20 a month.
The permutations, I could see, were endless. I’d used
up the battery juice in two telephone handsets and was
tangled in sheets of calculations.
Back to the SHIP lady, chipper even when I asked her
to run another set of formularies. Up popped a plan
for a mere $26 a month. It had no deductible and no
co-pays if I used only generic drugs. It allowed every
medication that I needed, once I’d fiddled with the
dosages and frequency (this after more calls to the
pharmacist).
But the plan seemed to require I use one of the large
chain drugstores. My loyalty to my local pharmacist,
especially now, made that unthinkable.
What’s one more call at this point, well into Day 3 of
this project? I called the insurance carrier with the
promising plan. Yes, a representative said, I could
use my own pharmacist for a slightly higher co-pay for
each drug, or $34 a month in all. Even someone as
math-impaired as I knew this was the best deal.
This is the moment to talk about how if time is money,
Medicare Part D could use some streamlining. It is the
moment to talk about how the government cannot expect
an elderly person with cognitive, visual or other
deficits to manage this task —and it cannot assume
that everyone has a daughter who can.
In three days, I learned two things: how grateful I am
to have found a plan that will pay for a generic
version of Ambien, so the next time I do this I won’t
have to spend three nights thrumming with tension
because I can’t afford to sleep. And how anticlimactic
—even celebratory —my 65th birthday will be, compared
with the run-up.
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