Medicare Part D:
(“D” is for Disaster”)
1121 Wayland Avenue
February 5, 2006
This program operates under a grant from the California Wellness Foundation
A Little Humor…
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but was repealed in 1989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
The Medicare Prescription Drug, Improvement,
and Modernization Act of 2003 (MMA) passed the
House of Representatives and the Senate in
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.
Democrats were denied opportunities to
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
Serious Ethics Violations
Tom Scully and Assistant, Jeff Flick
(Where are they now?)
Rep. Billy Tauzin and Rep. James
Rep. Nick Smith alleged that he was
offered a bribe on the House floor by
Drug Companies in Action!
In 2003, the Drug Companies…
hired 952 lobbyists
spent $141 million on
contributed more than $30
million to campaigns.
Drug profits rose $182 billion.
What have we got? Can we make
Does Medicare Part D reduce costs &
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?)
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
List of the Most Egregious Issues…
1. Enrollment = Chaos + Confusion.
2. Medi-Cal Beneficiaries are Treated
3. Late Enrollment Penalty
4. Retirees with Current Drug
Coverage – Beware!
5. The Donut Hole.
6. No negotiating for best prices!
7. People are supposed to have
choices… but they can’t be
8. The plans get to change prices,
formularies and deductibles at
any time, but you don’t have the
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.
Coverage began January 1, 2006 for those
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.
Part D Plans – The Basics
Plan Choice – 47 “stand alone” plans
in California in addition to current
Part D Plans can change formulary at
Customer service – up to each plan
Appeals - up to each plan
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.
Low Income Subsidy – The
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
First, you must apply for the subsidy, then you must
enroll in a Part D Plan.
What did the Governor just
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.
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
Who’s your State Legislator?
Your California Senate (Dist. 14 - Rep)
State Representative may Senator Charles Poochigian
Assembly (Dist. 25 - Rep) Capitol Address
Assemblyman Dave Cogdill State Capitol
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
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
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
Center for Medicare and Medicaid Services
(CMS): Call 1-800-MEDICARE or go to
CARA Part D Toolkit at
Remember, most other sources of information
are trying to sell you something
Enrollment = Chaos + Confusion
Enrollment is being pushed too quickly
Enrollment decisions are too complex
Too few resources are available to help
Too little information is available in multiple
languages and in formats easy for consumers to
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
The “Donut Hole” – Not a Sweet
You get no coverage for costs between $2,250
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
Many factors will make it difficult for individuals
to reach the other side of the hole ($5,100) and
to start getting benefits again.
America Can Do Better
After all that you’ve heard, what do YOU
Will Medicare Part D reduce cost, improve
access, and increase your ability to live a
We Get By with a Little Help from
CARA (Alliance for Retired Americans)
OWL (Older Women's League), California
Health Access California http://www.health-
Congress of California Seniors
Pharmacists Planning Services, Inc.
California Pharmacists Association
• This presentation made possible by a grant from The California Wellness Foundation.
Together We Can Get A Real
Prescription Drug Benefit
Here are at least 4 Ways you can help.
Circulate & advocate
Tell your stories
Organize & mobilize
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.
Call Your Congressional
Dial the House & Senate switchboard
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!
Be part of a team to follow-up on today’s
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
Let’s Change our Language
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
Remember, health care is a value. If you
belong to a church, synagogue etc.,
consider mentioning it.
Tell Your Story (or help your
Share your experiences and those of people
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.
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.
At the state level…
Organize & mobilize
Participate in state hearings on Medicare
Coordinate legislative visits in your area.
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
Are we laughing yet?