Dear Medicare Beneficiaries

Dear Medicare Beneficiaries,

As we all know, the Annual Enrollment Period (AEP) began yesterday October 15 th. Please be aware that there are 80 million seniors turning 65 over the next 15+ years so call waiting times will be long. Have patience with us, either Medicare, Social Security or your health plan provider. We are doing our best to accommodate and address the concerns you have with your current or prospective health plan. To expedite any inquiry please be prepared with your Medicare card, your health plan card, member ID and a list of any prescriptions you are taking. This will assist us in efficiently answering your concerns.
Also, please be aware that the AEP ends on Dec 7th so if you need any information mailed to you regarding your current or new plan please call at least two weeks before the AEP deadline. By doing this you will have plenty of time to review the information and call back to ask any questions or concerns you may have.
Medicare beneficiaries, I speak to you from the trenches of Medicare warfare. I am on the front lines and deal with seniors and their frustrations everyday. I am providing you with little secrets that will get you the answers you seek in a timely fashion. Take heed however, not everything you hear is gospel. You want to make sure you always confirm the information you receive from another source. If that means calling back then do so. Trust me when I tell you this…” You want to make absolutely sure that the terms and conditions of care provided by your health care provider are what you were expecting.” If it is NOT, then you must contact Medicare because you may have been mislead and this type of Medicare fraud can cost you dearly, both emotionally and financially.



Dear Medicare Beneficiaries,

If you have received a letter from your insurance provider stating that your current MAPD or PDP plan will be discontinued in 2013 you MUST ACT ACCORDINGLY DURING THIS AEP BETWEEN OCT 15th to DEC 7th. Doing nothing will either revert you back to Original Medicare A & B and or no drug coverage. Starting the year without drug coverage can be a hassle so to avoid receiving a Late Enrollment Penalty (for not having Rx coverage) do your due diligence and search for one. Contact your customer service, it’s more than likely they offer a comparable plan to the one you are losing. This also goes for individuals losing their Medicare Advantage (MAPD) plan as well.
Now, for those of you who DO NOT want to replace your MAPD with another one available in your area you have the option of reverting back to Original Medicare and picking up a Rx plan GUARANTEED ISSUE. THIS MUST BE DONE (App completed and submitted) prior to the last day in Feb. 2013. This guaranteed issue provision allows you to enroll into any Medicare Supplement plan without being subject to underwriting. For those beneficiaries who live in the northeast region of the US ( NY, ME, NH, & CT) underwriting is of no concern for you because it is illegal for insurance companies in these states to underwrite a Medicare beneficiary.
However, unfortunately for the rest of you, it is quite legal in other states for insurance companies to weigh the risk of enrolling you as a member. They have the right to deny your enrollment based on the risk you may cost them. Is this fair? Not in my opinion but you have to remember that insurance is a business. As a consumer you must approach the selection process of a plan in the same manner. Do the research and find out which plan offered in your area works best for you.
Retrospectively however this may be an opportunity for you, as a consumer, to seize the moment and take advantage of the loop holes the system has created. What I mean is simply this… For any individual enrolled into Medicare A & B, if your health is where it should be at your age or better (meaning you are quite healthy, and only visit your PCP or a specialist a couple times a year) then enrolling into a MAPD would be beneficial. Your premiums are relatively low and your co-pays for services provided would be minimal because you don’t seek treatment for any issues often. This coincidally keeps your out of pocket expenses (OOPE) low. However if your health is declining and you KNOW that you DO or WILL NEED to seek treatment for conditions that ail you the Medicare Supplement route might be the best path to take. This is where you can take advantage of the system. Normally, any Medicare beneficiary outside of the states I mentioned above looking to enroll into a Medicare supplement plan (outside of their initial enrollment period [IEP]) would be subject to underwriting which may prevent you from being enrolled and getting coverage. Coincidentally however, since your MAPD is being discontinued in 2013 (no longer available) that gives you an SEP or special enrollment period that allows you to enroll into any Medicare Supplement plan guaranteed regardless of your health condition. This is a tremendous benefit because if you can afford the premiums then you will be eligible for the most comprehensive plan (Plan F) out there.
I understand that this situation is annoying and cumbersome but trust me when I tell you this “you are better off doing the research to find a plan similar to what you have or different; it doesn’t matter.” AS LONG AS YOU FIND A PLAN TO REPLACE WHAT YOU ARE LOSING BEFORE THE END OF THE YEAR. If you sit and do nothing, come the new year your OOPE will be drastically higher than what you are used to. My advice is take the time with someone to go over your replacement options so you are aware and can forecast your health care expenses for 2013. There’s nothing more frustrating than looking for financial assistance with your health care costs and being left in the wind to cover it yourself…..unless you “Got it like that!”

Prescription Drugs Don’t Come Cheap

Drug companies are at it again… Not only do they ruthlessly compete for large percentages of the prescription drug market, but now that ‘top-selling’ drug patents are expiring, they are cleverly finding ways to keep some consumers coming back for more. Quick question, “How many of you out there are bargain shoppers?” I would hope all, why waste money when you can get it for cheaper, right? Ok, “How many of you out there use coupons?” I can see thousands of ladies raising their hands right now with coupon clippings in hand, like ” Ooooh, I do, and I’m really good too. Saved myself $34 and some change last time out!” God I love the savvy consumer. Now, try putting those two concepts together and this is what you get…

As current economies, both the US and worldwide, continue to struggle, and health care costs steadily increasing, the price of doing business for prescription drug companies like Pfizer and the like is becoming too much to handle. Research and development for future drugs has become a more scrutinized process by the FDA, costing drug companies billions of dollars before getting final approval. In order to recoup this initial investment, the government has allowed Drug Companies exclusive rights to the market for 10-15 years before a generic equivalent can even be offered as a cost-saving solution to patients. So, after billions in profit and the drug companies’ patent is about to expire, one would think the smaller companies putting out generics can now get a piece of the pie, right? Wrong. Large Rx drug companies aren’t going to just ‘hand over’ a large part of the market like that without kicking and screaming. So, what have they done to offset this? You guessed it! Coupons.

Drug companies are taking a strategic and tactical but simplistic approach to offsetting the loss of billions of dollars in revenue to generic drug makers by offering existing or prospective patients coupons for discounts on monthly brand name prescriptions. I mean think about it, what better way to maintain a small percentage of your clientele base than to offer them incentive to stick around? Times are tough man; we have to save wherever we can, but (and drug companies love this…) we are also creatures of habit. We trust who we trust, who we know, even if that means spending a few extra dollars. This is exactly what large Rx drug companies are banking on. When the patent expires on brand name drugs, generic equivalents flood the market and can be offered for as low as 90% below the cost of brand names. At this point, most consumers usually switch. A massive drop-off of consumer brand loyalty costs drug makers billions, unless they can ‘slow the bleeding.’ In this case, drug companies that offer coupons are effectively killing two birds with one stone. Here’s how…. By offering coupons, consumers are happy to maintain their brand loyalty without having to pay as much as before. And most importantly, they can continue to use a drug that they know works for them versus taking the chance with an unproven generic and its side effects. This is great news!… except for one thing…. “The coupons only work with private insurance, though. Patients with Medicare or other government health insurance are barred from using them.”

Hold on a sec. So, if I understand this correctly, Rx drug companies are only going to incentivize people with private insurance? Isn’t that discriminatory? Yes. And there’s nothing you can do about it. If you are a Medicare beneficiary or qualify for government health insurance, like Medicaid, you do not get to participate in the coupon party. That stinks!!! Medicare/Medicaid beneficiaries who live off of Social Security/Supplemental Security Income (SSI), respectively, are expected to continue to pay the rising costs of Rx drugs or they are forced to switch to generics. Has anyone considered the ramifications of this?! What if seniors or these low-incomed individuals end up worsening their health condition due to the side effects of switching to generics? What happens then? Are we to just look the other way, and tell them to “stick with what works?” Oh, and by the way, in order to safely monitor your condition, you will need to continue to spend hundreds of dollars a year, even though we know you cannot afford it. So much for keeping the consumer’s best interests at heart. Where’s the compassion? Im sorry, I forgot that we were talking about Rx drug companies here. It’s a business and only that. As long as their bottom line doesn’t fall too far too fast that is all they are concerned with.

Not surprisingly, commercial insurers don’t like the coupons, because their share of the cost for a brand-name drug is much higher than for a generic pill. Virtually all prescription plans automatically switch patients to a new generic drug [once available] the next time they refill their prescription. The [Rx] plans also move the drug from the copayment level [usually Tier 2] for most brand-name drugs, usually around $25, to their highest copayment level [usually Tier 3], often $50 to $75 per prescription. [This is to force patients to accept the move to generic drugs because Tier 3 drug cost-sharing for insurance company is more expensive than the cost-sharing for a generic; this method is preferred by the insurance company, regardless of the effect, whether financial or physical, on the beneficiary.] The coupons throw a wrench into insurers’ strategy of getting as many patients as possible to take generic drugs, which account for about 80 percent of all prescriptions filled in the U.S. [To combat this, drug makers are] also signing unprecedented deals with dozens of insurers that lower their (the insurer’s) portion of the cost of [a brand drug] to what a generic would cost them — [as long as] they covered only brand [name ‘X’] for [x amount of time]. That meant both patients and insurers had a big financial incentive to stick with [the brand name drug] for a while.

Drug makers use coupons to fight generics, by Associated Press Aug, 20,2012

So, where do we go from here? I don’t know, it’s tough to say. For right now, it is what it is. Medicare/Medicaid beneficiaries are excluded from the rewards of brand loyalty. I apologize that I unfortunately could not give you any definitive answers as to how to approach or circumnavigate this issue. I hope by asking questions about these incentive ‘kick-backs’ I might be able to raise eyebrows for someone, somewhere, who in a place of power or authority can say ” What are we doing, are we really allowing this to happen?” By generating discussion we can bring to light our concerns. Until then, only time will tell.

Medicaid Providers, Where Are They?

Medicaid.  A highly publicized and scrutinized social insurance program established for those with low income has seen a wavering sense of support recently, especially with the decision of the Affordable Care Act.  Sarah Kliff, a writer for the Washington Post, has written about Medicaid and the gleaming show of support by its enrollees in California, stating that more beneficiaries than expected actually like their health coverage offered by the program.

Here’s the thing….  Medicaid has been known to offer low reimbursement rates to physicians across the country, causing many providers to not accept new Medicaid patients.  Not only is this a major concern for the social insurance program, but accessibility to care as well.  Here is where this article, Actually, Medicaid enrollees really like their coveragecan be a little misleading to the uninformed.  It is true that out of the 1,083 Medicaid enrollees that were surveyed, 9 in 10 said that Medi-Cal (Dual eligible individuals who have Medicare and Medicaid) services were “very good” or “pretty good.”  Not to sound callus, but any type of ‘free’ insurance should be considered “very or pretty good.”  I mean, lets be honest here.  If an individual cannot afford to pay for insurance to manage their’s or the  well-being of their loved ones, can they really be critical of they type of care they receive?   I, for one, believe that regardless of an individual’s economic or social standing, the care provided to them from a professional should be of the upmost quality (within means of course).  If the nation’s hard earned tax-payer dollars are going to do something, then it might as well be to get these individuals healthy and back working again.  Unfortunately, not every Medicaid beneficiary is experiencing this quality of care.

This was kind of what I was eluding to earlier when I made mention of the uninformed.  You see, a large population of Medicaid beneficiaries reside in the geographical areas of the the Southern United States, where rural, not urban, culture holds reign.  It is here where more Medicaid beneficiaries struggle to receive the type of care that would get them back on their feet.  Access to quality care in these states suffers because there are few doctors in these areas to provide care for the millions of enrollees in the social insurance program.  This unfortunately creates discontent for the program for many individuals.  They do not have accessible means to receive the care they need; that they are entitled to as Americans.  Hence spawning the viral, infectious perspective that this country does not care for or has forgotten about them.  Did I forget to mention that a lot of these individuals are seniors, they’ve fought for this country and helped America become the “Land of the Free and the Home of the Brave?”

Ooops, my bad.  (Yes, I admit I did that on purpose, …but for a reason).  Not all is what it seems.  The point I am trying to make here is that Medicaid and its struggles are affecting more individuals than we think.    It could be your mother or father, your grand parents or aunts and uncles, brothers and sisters.  And it expands across generation gaps and racial divides.  These tribulations are felt by beneficiaries across the nation.  Quality and accessibility in California, for instance, can and must improve.  However, due to population density, accessibility isn’t much of an issue there, where as in more rural areas of the south, accessibility is of major concern.  How can you grade the quality of care provided when patients have no means of access?  The ACA is looking to change this but in order to do so the federal government needs help from individual states.