Medicare Part D – as in D for Disaster

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					     Medicare Part D:
   (“D” is for Disaster”)
                      Margie Metzler
               1121 Wayland Avenue
                  Sacramento, CA
                    916-921-5008
              margiemetz@hotmail.com
              Website: www.gpcal.org
                  February 5, 2006


This program operates under a grant from the California Wellness Foundation
A Little Humor…




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Our Motto




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       History
   Medicare enacted in 1965
   1988, a prescription drug benefit was attempted
    but was repealed in 1989
   The Clinton Drug plan had a drug benefit: 1993
   Clinton admin. tried to provide drug coverage
    under new Medicare Part D. It failed in the
    Senate
   The Medicare Prescription Drug, Improvement,
    and Modernization Act of 2003 (MMA) passed the
    House of Representatives and the Senate in
    November 2003

                                                      4
     Ugliness in the Background
 Cost estimates were withheld: Bush,
  Sec. of HHS Tommy Thompson, and
  CMS admin. Scully said cost would not
  be more than $400 Billion over 10 years.
 Richard Foster, the Medicare actuary,
  predicted it would cost as much as $600
  Million. His job was threatened.



                                             5
     Background 2
 Democrats were denied opportunities to
  offer amendments.
 The vote was held open for three hours
  in the dead of night. HR 1 was brought
  before the House for final passage at 3
  a.m. Sat., Nov. 22, 2003.
 Thompson was allowed on the floor to
  persuade members.


                                            6
     Serious Ethics Violations
 Tom  Scully and Assistant, Jeff Flick
  (Where are they now?)
 Rep. Billy Tauzin and Rep. James
  Greenwood.
 Rep. Nick Smith alleged that he was
  offered a bribe on the House floor by
  Tom DeLay


                                          7
    Drug Companies in Action!
In 2003, the Drug Companies…
    hired 952 lobbyists
    spent $141 million on
     lobbying
    contributed more than $30
     million to campaigns.
 Drug profits rose $182 billion.
                                    8
     What have we got? Can we make
     it better?
Does Medicare Part D reduce costs &
 improve access?
                    OR
Does it simply privatize a major part of
 Medicare by turning over drug coverage
 to an unregulated army of private drug
 providers (while sacrificing the standard
 benefits fundamental to Medicare?)

                                             9
       Advice in a Nutshell
 Ifyou have good coverage in a private
  plan now, STAY PUT!
 Save    every piece of paper you get
  from your current plan, Medicare, Social
  Security, Medi-Cal etc. Store in a safe
  place and make backup copies. Check
  with HICAP.


                                             10
     List of the Most Egregious Issues…

1.   Enrollment = Chaos + Confusion.
2.   Medi-Cal Beneficiaries are Treated
     Badly.
3.   Late Enrollment Penalty
4.   Retirees with Current Drug
     Coverage – Beware!
5.   The Donut Hole.


                                          11
      More Egregious…
6.   No negotiating for best prices!
7.   People are supposed to have
     choices… but they can’t be
     informed consumers
8.   The plans get to change prices,
     formularies and deductibles at
     any time, but you don’t have the
     same options.

                                        12
     The Implementation…
 Medicare/Medicaid     People are the
  first. On Jan. 1 they were all moved
  to one of the plans.
 Medicare-only people can register
  at any time, but are strongly
  encouraged to “enroll” by May 15.
  There is no carrot, only a stick.


                                         13
      The Basics
 Coverage began January 1, 2006 for those
  enrolled
 Available for all people with Medicare, but
  impacts particular groups differently
 Drug Benefits provided through Private Plans:
   Prescription Drug Plans (PDP’s)
   Medicare Advantage Plans (HMO’s)
 Some Employer and Union Retiree Plans
  receive government subsidies to help prevent
  them from dropping drug coverage.


                                                  14
     Part D Plans – The Basics
 Plan  Choice – 47 “stand alone” plans
  in California in addition to current
  HMO plans
 Part D Plans can change formulary at
  any time
 Customer service – up to each plan
 Appeals - up to each plan




                                          15
     Don’t Blame the Pharmacist!
 Pharmacists  are on the frontlines:
  paying co-pays other costs.
 Many of them are working hand-in-
  hand with the rest of us advocates.




                                        16
17
       Low Income Subsidy – The
       Basics
   SSI and Medi-Cal people were automatically enrolled
    January 1, 2006.
   Those with incomes OVER this level and UNDER 150%
    of poverty level are eligible for low income subsidy but
    must apply through Social Security for this benefit.
     – Single – up to $1197 monthly
     – Couple – up to $1,604 monthly
     – Excess assets may prevent you from getting this
       benefit.
   First, you must apply for the subsidy, then you must
    enroll in a Part D Plan.


                                                               18
   What did the Governor just
   do?
 Authorized  the State to pay for
  medications for those Medi-Medi’s who
  are unable to get their drugs paid for by
  Medicare until Jan. 27.
 Was recently extended till May, and
  we’re hopeful for more extensions. This
  coverage was originally only for the
  period starting January 12 through
  January 27, 2006.

                                              21
       Low-income Medicare
       Beneficiaries Not on Medi-Cal
•   A two–step process
•   Apply for a “low-income subsidy” if
    income and assets are low
    – Single – up to $1,197 monthly
    – Couple – up to $1,604 monthly
    – Assets limits vary
•   Choose a prescription drug plan
    before May 15, 2006 and enroll – your
    subsidy should be automatically
    applied.
                                            22
        Who’s your State Legislator?
Your California              Senate (Dist. 14 - Rep)
  State Representative may     Senator Charles Poochigian
  be:
Assembly (Dist. 25 - Rep)       Capitol Address
  Assemblyman Dave Cogdill      State Capitol
                                Room 5087
   Capitol Address              Sacramento, CA 94249-0001
   State Capitol                (916) 651-4014
   Room 4117                 District Address
   Sacramento, CA 94249-        4974 E. Clinton Way Suite 100
   0001                         Fresno, CA 93727
   (916) 319-2025               (559) 253-7122
District Address
   1912 Standiford Avenue    Or… you can go here,
   Suite 4                     http://www.assembly.ca.gov/co
   Modesto, CA 95350           mmittee_hearings/ or look it up
   (209) 576-6425              in the phonebook

                                                                 23
     Where You Can Go For Help
 Health Insurance Counseling and Advocacy
  Program (HICAP): Call 1-800-434-0222 to reach
  your local HICAP or go to www.calmedicare.org.
 Social Security: 1-800-772-1213 or go to
  www.ssa.gov.
 Center for Medicare and Medicaid Services
  (CMS): Call 1-800-MEDICARE or go to
  www.medicare.gov.
 CARA Part D Toolkit at
  www.retiredamericans.org
 Remember, most other sources of information
  are trying to sell you something

                                                   26
      Enrollment = Chaos + Confusion

 Enrollment is being pushed too quickly
 Enrollment decisions are too complex
 Too few resources are available to help
  consumers
 Too little information is available in multiple
  languages and in formats easy for consumers to
  understand.




                                                    29
    Late Enrollment Penalty
    Lasts A Lifetime!
   Beneficiaries not automatically enrolled have until
    May 15, 2006 to chose a plan.
   After May 15, 2006, if you have not chosen a plan,
    you will pay 1% of the average area premium PER
    MONTH…FOR LIFE as your penalty!
   Example – say the average monthly premium in
    your area is $50 a month. If you wait 12 months to
    sign up, your premium would be $50 + $6 (12% of
    $50) every month or an additional $72 per year
    forever! If the rate goes up, your penalty goes up
    proportionately. If you wait longer, the penalty just
    keeps growing.


                                                            31
      The “Donut Hole” – Not a Sweet
      Deal
 You get no coverage for costs between $2,250
  and $5,100
 You keep paying premiums but get no benefit
 It is unclear what drug costs will get counted
  toward the $2,250 (i.e. all out of pocket costs
  or only those that show up in the Medicare
  computer)
 Many factors will make it difficult for individuals
  to reach the other side of the hole ($5,100) and
  to start getting benefits again.

                                                        33
   America Can Do Better
After all that you’ve heard, what do YOU
think…
Will Medicare Part D reduce cost, improve
access, and increase your ability to live a
healthy life?




                                              38
           We Get By with a Little Help from
           Our Friends…
   CARA (Alliance for Retired Americans)
    http://www.californiaalliance.org/default.asp
   OWL (Older Women's League), California
    http://www.owl-national.org/
   Health Access California http://www.health-
    access.org/
   Congress of California Seniors
    http://www.seniors.org/
   Pharmacists Planning Services, Inc.
    http://www.ppsinc.org/
   California Pharmacists Association
     http://www.cpha.com/AM/Template.cfm?Section=CPhA_Home

•   This presentation made possible by a grant from The California Wellness Foundation.




                                                                                          39
   Together We Can Get A Real
   Prescription Drug Benefit

Here are at least 4 Ways you can help.
 Circulate & advocate
 Educate
 Tell your stories
 Organize & mobilize



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       At the national level…
       CIRCULATE & ADVOCATE
 Tell people about the problems with Part D and urge them
  to join the fight for a Real Drug Plan.
 Join Gray Panthers and participate in meetings in your
  area. Call 916 921-5008 for the network in your area or
  to start a new one.
 Organize to hold your representative accountable for real
  relief from high drug costs
    Support HR 3861, the Medicare Informed Choice Act
     (Stark, Schakowsky) to extend the deadline
    Support HR 752 (Stark, Berry) the Medicare Prescription
     Drug Savings and Choice Act, to create a uniform drug
     benefit in Medicare and require that Medicare negotiate for
     the best possible prices.

                                                                   41
          Call Your Congressional
          Representatives
   Dial the House & Senate switchboard
                          1-202-224-3121
 Ask the operator for the first representative you want to reach
 When connected: “Hello, I live in your district and I’m calling to
  ask you to:
    Support HR 3861, the Medicare Informed Choice Act to
     extend the enrollment period and protect against bad choices.
    Support HR 752, the Medicare Prescription Drug Savings and
     Choice Act, to create a uniform drug benefit in Medicare and
     require Medicare negotiate for the best prices
    Reconsider & replace Medicare Part D with real reform that
     saves Medicare and provides relief from high drug prices.”
 Repeat until you have called all 3 of your representatives!
 Call today, call often, get your friends to call too!


                                                                  42
     Educate
Be part of a team to follow-up on today’s
 presentation.
  Take what you’ve learned today back to other
   groups you’re involved with
  Let us know if people are interested in further
   presentations (call (916) 921-5008)
  Write a “Letter to the Editor” about the pain
   and confusion Medicare Part D is causing


                                                     43
      Let’s Change our Language
      (Lakoff-ian Stuff)
 Don’t blame Medicare, blame privatization!
 Don’t talk of “enrolling” in a program, talk
  about buying insurance.
 HSA’s: they’re not savings accounts;
  they’re High Deductible private insurance
  plans
 Remember, health care is a value. If you
  belong to a church, synagogue etc.,
  consider mentioning it.

                                                 44
 Tell Your Story (or help your
 friends….)
Share your experiences and those of people
  you know
   Tell your story today!
   Collect stories from others tomorrow
   Host a local meeting to get the press to
    cover the “dangerous side” of Part D.




                                               45
       Use Our Form if You’d Like…
…or you can just use any
 old paper. We’d love to
 have people who are
 willing to testify, but we’ll
 protect your anonymity if
 you wish. We know that
 real stories are more
 effective than statistics in
 the advocacy process.


                                     46
     At the state level…
     Organize & mobilize

 Participate   in state hearings on Medicare
  Part D
 Coordinate legislative visits in your area.




                                                47
      Reach Out To Potential Allies
 Gray Panther member groups
 Local senior and disability advocacy groups
 Pharmacists and their organizations
 Non-profit housing providers to seniors and
  persons with disabilities
 Nursing Homes & Residential Care Facilities
 Legal Services Programs
 Paid and family care givers



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Are we laughing yet?




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