This is MORE than just getting rid of Medicare Part D. Right now, the FEDS are at fiscal risk for the cost of covered services by Medicare parts A&B. Medicare Part D is provided by FOR PROFIT INSURANCE COMPANIES. There seems to be nothing mentioned in this to suggest that Medicare ADVANTAGE is going to be changed or eliminated…. and that Medicare prgm is provided by FOR PROFIT INSURANCE COMPANIES and typically provides coverage for medications.
So many pts will have no choice but to move over to a Medicare Advantage prgm, to get their necessary medications covered…. to some degree.
When Obama first proposed Obama Care… Medicare Part D copays were suppose to gradually change until in 2020… it would be a 80%/20% payment schedule- for all medications… SURPRISE… when 2020 Part D info was released for open enrollment for 2020… we got notified that we would have a NEW $435 annual deductible. For years, – 2006 for Barb – we had Silver Scripts… which is now owned by CVS Health and uses Caremark as the PBM – which CVS Health also owned.
In using the Medicare website to check for other Part D providers… I discovered that Silver Scripts had been financially SCREWING US… Human Part D estimated that our costs would be much lower… in reality, in 2020 our total out of pocket copays – including the $435 deductible that we did not have in 2019 — was MORE THAN HALF than Silver Scripts charged us in 2019 with NO DEDUCTIBLE… Human’s premium was abt $1.00/month more … We are taking the same meds and using the same independent pharmacy.
Generally with Medicare Advantage prgms, they have limited networks of providers ( prescribers, pharmacies, labs, hospitals ) none could be providers that you prefer to use. You use a “out of network provider” your copay or deductible could be DOUBLE or TRIPLE what you have to pay by using a in network provider or get no coverage at all.
What happens if the reimbursement that the Medicare Advantage program drops the $$$ that they offer a prescriber is “too low” and they claim that >50% of practicing prescribers are 55 + y/o and decide to retire. All of a sudden mid-level practitioners ( ARNP, NP, PA, PharmD) before the primary care provider…. After all, mid-levels currently get reimbursed at abt 85% of what a MD would get paid for the same/similar service/treatment.
What would happen if/when 10% or so of Medicare folks remain on Part A&B, could Congress just tell them … Medicare Part A&B will cease to exist as of a certain date… chose a Medicare Advantage prgm by a certain date or we will assign you to one.
Then there are Medicaid pts…. most are getting their medications via a Part D prgm.. are the states going to have to reinvent “the wheel” or just go along and put all their Medicaid folks into a Medicare Advantage prgm – and then we would have > 50% of the population covered by Medicare Advantage prgm.
We have, at most. a handful of insurance companies controlling the vast majority of health insurance coverage/policies.
what happens if Congress mandates that everyone MUST HAVE HEALTH INSURANCE and EVERYONE will pay a certain percent of the gross income for a Medicare Advantage prgm… that would make those who think that the RICH SHOULD PAY MORE… that would be a VERY PROGRESSIVE TAX and another step toward a national health insurance. Do you know these 3 Tips for Driving Through Heavy Construction? Find more about insurance plans here.
The last segment is the companies that are self insured ( ERISA ) prgms… as the FEDS won’t increase what they pay these Medicare Advantage … they may increase what they pay by 2%-3% when overall medical care cost is increasing 6%-8%… so these insurance companies will have to look at their internal overhead costs… They may have to come to the conclusion that they are going to have to increase their administrative costs to manage self insured programs… or elect to get out of that service all together and give these self funded programs to sign their employees up to a Medicare Advantage type program or tell the large employer to manage their program themselves.
The graphic at the bottom of this post show where the “lion’s share” of the $$$ when a pt gets a Rx filled at their local pharmacy.
We have to remember that all it takes is one earthquake to create a tsunami and one “loose flake” to generate a avalanche.
Tell Washington To Protect Medicare
Tell Congress to Stand Up and Protect Medicare NOW!
Americans don’t need another barrier to their medicines. Despite this, some in Congress are considering legislation that would give the federal government unprecedented, sweeping authority to set medicine prices. These politicians want to repeal the provision of the Medicare Part D program that protects coverage and access to medicines for seniors and people with disabilities.
Seniors and people with disabilities have robust access to medicines in Medicare Part D due in large part to a protection known as the “noninterference clause.” This clause prohibits the Secretary of Health and Human Services from interfering in the private negotiations between manufacturers, pharmacy benefit managers and Medicare Part D plans. Unfortunately, some in Congress want to repeal this important element of Part D. Without this protection, government negotiations could directly and negatively impact access to lifesaving medicines for patients.
Congress must reject proposals that would repeal important protections for seniors and people with disabilities on Medicare and work on real solutions to improve the affordability challenges that many of them experience at the pharmacy counter.
Tell Congress there is a better way. Protect Medicare.
Filed under: General Problems
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