Healthy Policy has some information on the impact of Medicare Part D on people’s drug costs . (Unfortunately, if no one signs up for it because it’s so damn confusing, we’re going to get nowhere.)

Also: If you don’t sign up by May 15, 2006, you have to pay a higher premium!

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Yes, I realize how silly this is that this is online, when many seniors don’t feel comfortable with computers , but I’ll do my best. Medicare also has its own walk-through , but it’s 137 steps long. (Nope, not joking!) You can also call 1-800-MEDICARE (1-800-633-4227) for help, but I have no idea how long the wait will be.

Before we start, I’d recommend getting your pill bottles or list of medications in front of you. And maybe a glass of water. This may take awhile. Here we go, kids:

Hold down the shift key and click on this link . (When I say click, I mean take the left mouse button–or the only mouse button on some computers–and click.) This will take you to the Medicare Calculator and open a new window, while leaving this one open. Here’s a clip of what you’ll see (without the pink and grey box):

That pink and grey box is your key. That usually means there’s something important. Click on that first link, “Compare Medicare Prescription Drug Plans.” That’ll bring you here:

Now click on the orange arrow on the right side of “Find a Medicare Prescription Drug Plan.” Okay so far?

Next, if you’d like, you can enter all your info from your Medicare card in the top area that says “Personal Information.” To enter information throughout this tutorial, you left-button click on the box where you’d like to enter information, and then start typing, just like this one:
For the general search, which will work just fine, click the “General Search” box:

Now it gets confusing. First, enter your zip code in the box. That’s #1 on the graphic.
The next step requires your own personal information. If you have some other way that you get medications–maybe through Medicaid, your previous or current employer, etc, click the appropriate box. For most people, just click the box next to “None of the above.” It’s pink-grey highlighted as #2. (Any box you check takes you to almost the same page anyway. Sigh.)

Next, are you qualified for an extra discount on drugs according to your income and the Social Security Office? If not, click “No,” #3.
Then click continue, #4:

Next, click “Choose a Drug Plan Type.” Keep going, you’re doing great!

Now they want to know if you have Medicare Advantage, also known as Medicare+Choice, which is already helping pay for your prescription drugs now . If you have no idea what I’m talking about, click the lower box, “Search for Medicare Prescription Drug Plans.” Otherwise click the top box. Now you’ll see:

From here, you can start viewing the plans in your area. However, since the best deal you’ll get is based on the medications you take, I’d recommend entering them in the system. If you don’t want to do this, just click “View Plan List.” If you’d like to follow my recommendation, select “Enter my Medications.” Great!

Here’s why I had you get your medicine bottles out: You need to enter the name of each (either the brand name or generic name is fine) in Box #1. The click the button (#2) to add the medication.

If all goes according to plan, the medication will appear down below, in this new pink-grey box #1. If there are multiple medications with the same name, or if the system is confused about a generic name, it’ll make a display like in box #2. Simply click the medication name you wanted, and click box #3. Once you’ve got everything entered and every medicine appears in box #1, click box #4. (Note: some medications will not be in the system, and I have no idea what this is. I tried different medications, spelled correctly, and they couldn’t be found. I’m not sure what to do about this. I’m sorry.)

Once you click the “Continue” box, you’ll stay on the same page, but another box will pop up.

If you’d like to enter your specific medication dosage (10 mg or 20mg or 40mg, for example), click the “Choose My Drug Dosage” button. In the effort of simplification, we’ll skip this step–besides, you can do it later if you’d like.

Likewise, if you want to pick up your meds at a specific pharmacy in your area, you can do that now with the “Select My Preferred Pharmacy.” But note: certain plans may work with some pharmacies and not others. If you want the absolute lowest cost, click “Continue to Plan List.” If you want to pick your pharmacy from one locally, click “Select My Preferred Pharmacy.” Also note: if you want to get your meds by mail, the Plan List page will show you which plans will mail your drugs to you.

Finally! We’re on the list of your plans! They’re sorted by lowest yearly price. The rest of this just explains the final plan page with letters:

A: Click this box and up to 2 others to compare three plans. Click C to do the comparison.
B: Click this box for more options about the plan–the exact costs, how much you could save if you only used generics, enroll in the plan, etc.
C: See A.
D: Change your mind about wanting a specific pharmacy? You can do that here.
E/F/G/H: Here you can update the pill strength of each medication, or add more.
Now, if you want to sort the plans by something other than total yearly price, you can click on the column title and change it. Note that all these numbers really depend on what drugs you take, so it’s important to enter them accurately. Remember, Annual Deductible is how much you pay until Medicare starts paying its 75% for your first $2,250. Monthly Drug Premium is how much you pay per month to take part in the plan no matter how many drugs you use, and Monthly Cost Share is how much you pay as a co-pay when you get the drug.

I really hope this helped someone. Damn long writeup by my standards.

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Medicare, the insurance system for folks 65 and older, is about to get another addition tomorrow to provide prescription drugs to enrollees. There’s only one problem: it’s a complete disaster, and should be an embarrassment to every Congressperson that supported it. The following is an attempt to make sense of Medicare Part D in all its bureaucratic glory. I’m trying to write at a level anyone can understand, so you, or your parent, or your grandparent can understand it. It is not simple, and getting frustrated and confused is not a sign of stupidity.

A little background: Medicare has a couple parts. There’s Part A, which covers hospital care, and is pretty much automatic when the clock strikes midnight on your 65th birthday. There’s also Part B, which covers doctor visits, and costs those that signup for it $78 per month. Almost everyone has Parts A and B. There’s also Medicare Part C, which was passed in 1997 by the Newt Gingrich Congress, which allows people to enroll in an HMO for their Medicare, which can provide them with prescription drugs. (AKA Medicare Advantage, Medicare+Choice.) It could be its own post , so I won’t delve too far. Now, most folks love Parts A and B, which, not coincidentally, most people have. You turn 65, you check a box on a form, send it in, and you’re covered if you go to a doctor or have to be hospitalized. Easy as pie. Unfortunately, Medicare didn’t cover drugs, which are commonly needed by seniors, so the people said “We need drug coverage.” And All Was Good Bad.

But this new Medicare Part D isaster is no simple box checking. A senior can’t just say “Yes, I’d like cheaper medications,” and then the government does that whole “Helping the People” thing, because that’s the whole reason the People wanted the government in the first place. Medicare Part D requires a senior to compare plans–up to 85 in one area–and choose one based on a number of different factors and numbers. (It should be noted that this system was made under the guise of choice– the bill was heavily influenced by lobbyists . Take a second and ask yourself about the choice: do you honestly care which company provides your medications? Probably not. You just care that you can get them cheaper and have access to them when you need a refill.) You might think that there’s no precedent for such a simple, straightforward plan without the bureaucratic nightmare, but it’s not the case. There’s at least two: the Veteran’s Affairs hospital system and the state-run Medicaid program (which provides insurance for the very poor). These systems are not perfect, but their bureaucracy causes headaches for administrators, not for patients. Also note this: the law that made Part D specifically forbids Medicare from using its bulk purchasing power to get cheaper costs on medications for patients, but Medicaid and the VA both do this, too.

So how is this Medicare Part D thing supposed to work? In a perfect world, a person picks a Prescription Drug Plan (PDP) from one of many offered by different companies. That PDP pays for part of their drugs, after the senior pays for some as well. The PDPs differ on how much you pay per month, how much you pay up front, how much you pay per drug pickup, which pharmacies you can get the drugs from, etc. As you can imagine, if you have multiple drugs, and your spouse does too, it can be a total nightmare. But wait Vanna, there’s more: our nifty little terror here has another catch. For the first $2,250, you and Medicare split the drug bill (Medicare pays 75%). After that, for the next $2,850 of drug costs, you, the patient, have to pick up the entire tab. Once $5,100 is reached ($2,250 + $2,850), Medicare kicks back in, paying 95%. People call this donut coverage; you get to eat a bite until you get to the middle, then you get nothing, but then you get donut again once (if) you get to the other side.

Seniors are completely confused by this Medicare Part D. (And if you’re even still reading, aren’t you too?) It’s almost to the point that Jeff Foxworthy could do his redneck routine: “If you’re 65 and have recently pulled out your last remaining hairs, you might have Medicare Part D.” You have people with advanced degrees not able to make sense of it. Heck, I have a background in health policy, I’m two years away from being a doctor, and it’s taken me a good while to figure it out. If you don’t believe me, see Medicare complexity may scare off seniors or Confusion Is Rife About Drug Plan as Sign-Up Nears . Plus: A classic “screw you, seniors” quote from Michael Levitt, Secretary of Health and Human Services, who oversees Medicare: “Health care is complicated. We acknowledge that. Lots of things in life are complicated: filling out a tax return, registering your car, getting cable television. It is going to take time for seniors to become comfortable with the drug benefit.” Mikey, Mikey, Mikey… those things are complicated, but they shouldn’t be. That’s no excuse.

I hesitate to even recommend the Medicare website , as it’s its own disaster, but I don’t like most of the other websites out there, and they don’t have a formulary list out there. Terms (also taken from here , and then I’ll explain the Medicare calculator. ( USA Today has a decent writeup , too.)

Formulary

A list of drugs that a company or plan decides it will carry. If a drug is “off-formulary,” generally your doctor has to make a special plea to use it and has to have a good reason. You also might have to pay more for it.

Deductible

What a Medicare member pays before drug coverage kicks in. Can be zero to $250 a year.

Medicare Advantage

Managed-care plans, such as an HMO. Medicare Part C. The plans may provide more services than traditional Medicare, but may limit members to certain doctors and hospitals.

Premium

A monthly payment for insurance.

Quantity limits

Dispensing limits on the quantity of a drug that can be prescribed each month.

Step therapy

Step therapy means a patient must try a lower-cost, often generic, product first. If it isn’t effective, the patient then “steps” to a different, often more expensive, drug.

Co-Payment (Co-Pay, Co-Insurance)

Amount you pay to get a drug after you’ve paid your deductible. Some plans have one flat rate, others have different rates based on the type of drug (brand name vs generic, newer vs older, etc)

If that wasn’t confusing enough for you, you clearly didn’t read carefully enough. Next will be a walk-thru (with pictures!) of how to use the Medicare Plan Finder thingy .

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Blogging is probably like sending angry emails: you should wait until you’ve calmed down. But I just can’t help it right now. I’m livid.

So I’ve become something of a patient advocate recently with all this geriatrics and frail elders and polypharmacy and whathaveyou, so I thought it’d be a good idea to try to get a grip on the Medicare Part D stuff that’s going around to physicians and Medicare recipients. (My father and grandma tried to attend an information session, but it was so crowded even at the encore performance that they couldn’t get in. Note: this is not a testament to how popular the new plan is; it’s a testament to how damn bureaucratic, confusing, and complicated the thing is.) So I do a Google search for medicare part d to get some general results. I get a ton of ads (a clear sign that there’s money to be made by all comers), and I click on some ads, some links. A mish-mash of everything to get an overview, and possibly recommend a site or two to my one or two readers.

I come to my first site, and this is the one that drives me over the edge: AARPMedicareRx.com . I see AARP in the URL, and assume it’s a special site the AARP has created to help its members. Then I see the AARP logo in the top left corner, and assume I’m right. I click on “Learn the basics,” and get this first paragraph:

If you’re eligible for Medicare, you have a new option for getting coverage to help with the cost of prescription drugs: AARP MedicareRx Plan is a prescription drug plan that is approved by Medicare. This national plan is provided by United HealthCare Insurance Company* and begins January 1, 2006.

I’m confused. “What? I thought there were multiple options for the Medicare Part D plan, not just one.” I re-read, I scroll down to the asterisk, and reailze I’ve been had. This is not an AARP site at all; no, it’s a United HealthCare Insurance Company website with an AARP (“pharmacy services” bullshit) logo. And if a third year medical student with a major in health policy and a pretty good understanding of the US health care system makes this mistake, you can bet countless others will, too. I’m sure that’s the goal. Show the AARP logo so you get the confidence of the AARP, then tell consumers there’s *one* new plan to help people out.

I’m disgusted. If anyone knows who I could contact to complain about this blatant deception, please let me know. (Isn’t this what the copyright laws were supposed to be for? Protecting consumers from misleading or fraudlent information?)

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