Archive for May, 2009

MEDICARE REFORM – TOP 10 THINGS WRONG WITH MEDICARE

PLEASE VISIT: WWW.TOP10THINGSWRONGWITHMEDICARE.ORG

There you can sign the Medicare Reform Petition and read the names of the other 1,000+ people who signed it and their amazing comments.  Below is just a copy of the Top 10 List on that website, but please go to the actual website and read what real people are dealing with everyday on Medicare!!!


1. Medicare cannot negotiate better drug prices with drug companies.

Why are there are NO price negotiations between Medicare and the drug manufacturers? This is the reason the prices on your prescriptions have gone up so drastically over the last few years.

Medicare should use its leverage, 44 Million Beneficiaries, to negotiate better prices. Instead, the government gave the insurance companies and drug manufacturers a blank check so that they could charge us as much as they pleased. You can only wonder how much money the drug and insurance companies must have contributed to political election campaigns. If you are still under the impression that we don’t need government regulations to stop corporate greed, you must be a CEO with your head in the clouds on your private jet.

2. Drug plans can change or cancel drugs they cover anytime, but beneficiaries cannot change their drug plans.

When you buy a medication that is not on the drug plan’s formulary and pay for it out of pocket, because you need it for survival, you cannot claim this expense toward your TROOP, True Out Of Pocket costs. Let’s assume that you have cancer and your doctor has found one particular drug that is now keeping you alive. If you choose to save your life and find a way to pay for this extremely expensive drug, this will not count toward your TROOP and help you reach the catastrophic coverage phase. If you could reach this phase, Medicare would pay 95% of your drug costs. Isn’t that so convenient for the drug and insurance companies?

No matter what the drug plan company decides to do, you are locked in for one year! They can decide NOT to cover your drugs and make you pay retail with no help. How is that for a fair and honest system? If you don’t join a drug plan or cancel your plan when you find out that your drugs are not covered, you pay a penalty of 1% per month for life! So, why is it that the cards are stacked so high in the drug and insurance companies favor? If we hand over our health care to Corporate America and let them make decisions, this is what you get.

3. Prior authorizations too complicated. Step therapy too restrictive. Quantity limits are not set by doctors, but by the drug plans.

Another way drug & insurance companies try to opt out of paying for our medication is to impose prior authorizations and step therapy. They say this is to cut down on abuse. Instead, it creates a system where the insurance companies are in control of your medications. Drug and Insurance companies are now making decisions that ONLY A DOCTOR SHOULD BE ABLE TO DECIDE. Your doctor should be the only person who decides what medication you should be taking, not an insurance company. Should your insurance company be making decisions on how much medicine you need to cure or keep your illness in check? Guess again!! We have literally given Drug and Insurance companies carte blanche with deciding who lives and who dies in this country.

4. Drug plans were designed for the benefit of insurance companies, not beneficiaries.

Medicare works great unto itself. Everyone pays into the system so that we all have a certain degree of coverage in our retirement years. When you have a system that works, but try to have it re-designed by Drug and Insurance Companies, this is what happens. WE DESPERATELY NEED TO GIVE MEDICARE BACK TO THE PEOPLE!! When Corporations own a country, people become dollar amounts on a profit statement and your life is only worth how much they choose to pay out to keep you alive.

5. MAPD (Medicare Advantage Plans with built in Drug Plans) advertising is misleading. Seniors can’t understand the differences in types of coverage.

Medicare Advantage Plans have cleaned up, sweeping in billions of our tax dollars, but giving us inferior coverage at the same time. The plans they came up with are very confusing, and a total mess. There is no network of doctors that will accept the terms of payment from the MAPD’s. Your doctor or hospital could accept your MAPD plan at one visit, and decide not to take it at the next appointment. Now, Seniors and Medicare Beneficiaries are so confused they can’t understand the differences between Original Medicare and Medicare Advantage Plans.

The drug and insurance companies purposely mislead you by saying that Medicare Advantage Plans offer more benefits than Original Medicare. They leave out the fact that someone with Original Medicare usually has a Medicare Supplement or Medigap Plan as well, whose benefits far surpass any Medicare Advantage Plan out there. You can choose your own doctors and hospitals anywhere in the country, and let your doctor decide what’s best for you, instead of some bean counter who is NOT working in your best interest, but the drug or insurance company he works for.

Why do we allow Drug and Insurance companies to deliberately create plans that are so complicated and confuse people to the point of overwhelming them? We all should understand that this is “great marketing” to take advantage of their confusion. Many times the slick salesperson will enroll Medicare Beneficiaries on MAPD plans not knowing if the plan will cover their illness or their medications. When you pay salespeople double and triple the amount to sell a certain kind of coverage, greed grows wild like kudzu covering the ground where “doing the right thing” used to prevail. Insurance Companies get rich at the expense of our health.

Another point of contention is when Independent Agencies and Salespersons ARE TRYING to do the RIGHT THING by offering plans that are BEST for each individual, they are routinely terminated and penalized by the insurance company for NOT selling what the insurance company WANTS them to SELL!!.

6. Drug Plan Comparison

shopping is supposed to begin Oct. 1, however Drug Plans do not send out ANOC (Annual Notice of Change) letters or updates on the next year’s formulary until it is too late.

Have you ever tried to find out what changes your drug plan is making for the next year’s coverage? It is like finding a needle in a haystack. You will be bombarded with tricky marketing pieces meant to confuse you, well before you receive the ANOC letter, many times too late for you to make a reasonable decision. Insurance companies have almost made these ANOC letters their last priority because they don’t want the beneficiary to change their drug plan. If every senior in America actually took the time to get a comparison of Part D plans Nov. 15th through Dec. 31

and make sure they were on the drug plan that would save them the most money while covering all their drugs each year, the drug plans would be losing money. The drug and insurance companies have made this task so daunting and confusing, seniors just give up.

7. Unacceptable Two year waiting period for people on Social Security Disability.

Imagine being 55 and becoming disabled due to an illness or accident. You lose your job and insurance. You finally begin to receive your Social Security benefits, but they tell you that you will HAVE NO HEALTH COVERAGE FOR 2 YEARS! WHAT??? Many people’s health gets worse, ultimately costing the tax payer billions more in health costs, or they pass away before they can become eligible for Medicare Health Coverage in the United States of America. Ever heard of “nipping it in the bud”? It seems Medicare wants to eliminate the problem before they have to fix it.

8. Dreaded Donut Hole causes beneficiaries to stop taking needed medications.

Studies have shown that seniors in the “dreaded donut hole” STOP taking needed medications because they must literally choose between food and filling prescriptions. That is no exaggeration folks! We used to say “SURVIVAL OF THE FITTEST”, but the insurance and drug companies have changed that to “SURVIVAL OF THE RICHEST”.

All Medicare Part D Beneficiaries receive $2,700 dollars WORTH (retail prices determined by each drug plan) of medications each year before they fall into the “dreaded donut hole” and MUST AGAIN PAY THE INFLATED RETIAL PRICES for their prescriptions with no help. When just one 30 day supply of some medications is so expensive, you can see how quickly that would add up. This causes the sickest of us to be unable to purchase needed medications.

One important way you can STAY OUT OF THE “DREADED DONUT HOLE” is to buy generics NOT USING OR MAKING A CLAIM ON YOUR DRUG PLANS. Pharmacies have begun telling Seniors that this is illegal. IT IS NOT ILLEGAL TO PURCHASE GENERICS OFF YOUR DRUG PLAN. IT IS YOUR RIGHT! Your co-pays may seem small for a generic; however the drug plan dings you up to $40 or more, pushing you into the donut hole much quicker. This inflated amount goes toward falling into the donut hole, not your co-pay charges! You can see how NOT using your drug plan for these generics could keep you OUT of the donut hole even longer each year saving you more money. Some Pharmacies won’t allow beneficiaries to purchase generics OFF their drug plans forcing them into the donut hole. The reason is that pharmacies do not get as much reimbursement if you pay without making a claim. Please, don’t let this happen to you! Let the pharmacy know YOU HAVE THE RIGHT TO CHOOSE WHETHER OR NOT TO FILE A CLAIM!

9. Drug Plans constantly passing the buck to Medicare for sorting out problems due to miscommunication and clerical errors.

Many people on Medicare have to wait months to get their drug plans to go into effect. No, it is not because they did not meet the enrollment guidelines. It could be because the drug plan procrastinated in submitting their enrollment to Medicare due to a clerical error and now tells the Medicare beneficiary their enrollment period has lapsed and are no longer eligible. The Beneficiary then goes back and forth between the insurance company and Medicare trying to correct a simple problem that seems uncorrectable. Medicare will tell them that the drug plan has not sent in their application for processing, the drug plan will say that Medicare will not approve the application due to inconsistency of a Medicare Claim number or date of birth on their records. How could such a simple problem keep someone from receiving health care and drug coverage? When did clerical errors become more important than a human life?

10.

LIS or Limited Income Subsidy Programs are the BEST KEPT SECRET of Medicare.

Many people could be saving thousands of dollars, but are never told about the Low Income Subsidy Program.

You would not believe how many people go to the local Social Security office asking for help and are never told about “extra help” programs. Many people who could quality do not even know they exist. The drug or insurance companies certainly don’t talk about it. You would be hard pressed to find a salesperson that would take the time to explain or educate their customers.

We know of thousands of people across the nation in Mental Health Facilities, Nursing Homes, Hospitals, etc…that have never been asked if they have applied for extra help or been told there is such a program. For months or sometimes years, the Facilities or their families have had to absorb the costs for these medications. However, even if someone finds out and is enrolled on a LIS program, many times the very drugs they need are not covered by the particular drug plan they were assigned. WHY? Medicare will arbitrarily assign a drug plan without checking to see if your drugs are covered by the plan. The drug company does not care if your drugs are covered. People must know to check for themselves. Since these plans are so confusing they cannot understand all the complicated formularies of drugs covered by each of the more than 50 drug plans available in each state, all with different pricing.

As you can see, Medicare needs to change and reform their policies. Please take time to email your local, state and national officials with this Top Ten List.

Pass it on to everyone you know, even if they are not using Medicare, their parents or friends could use this valuable information.

During the next few months the drug and insurance companies will begin to FIGHT to keep things as they are so they can continue to manipulate and control our very right to pursue health and happiness in these United States of America. Let them know you are not going to take it anymore.

Top 10 Things Wrong With Medicare

Sponsored by www.MyPartDusa.com/blog

@copyright 2009

Please write to me, Karyn Blake, here at My Part D USA’s blog at kblake@MyPartDusa.org. Or you can email this article to a friend.

Published by mypartdusa on May 27, 2009 in Where do I go for HELP with Part D or Medicare Issues?.

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TURNING 65 – NEW TO MEDICARE

EVERYONE KNOWS HOW CONFUSING MEDICARE CAN SEEM WHEN YOU ARE TURNING 65 OR NEW TO MEDICARE. All the different companies send you, or should I say bombard you, with their advertisements and information.  Everyone is overwhelmed, not just you!!

If you read the comments from other people that we have helped in the TESTIMONIALS, (right hand side of blog) you can see that for yourself.

I was honored to be on CNN 3 times last November during the Annual Election Period talking about how some of  the GENERAL MOTORS RETIREES had come to us for help during their transition from group coverage to Medicare coverage.  I was also honored to write a blog for one of the largest groups of GM Retirees www.OverTheHillCarPeople.com They needed information about what they could expect after they had lost their group coverage.

As always we recommend a MEDICARE SUPPLEMENT/MEDIGAP PLAN COMBINED WITH A STAND ALONE PART D DRUG PLAN , instead of a Medicare Advantage Plan.  You can read more about the differences and why we do this by going to the categories section (left hand side of this blog) and clicking on those topics.  With a Medigap Plan you can go to any doctor or hospital of your choice and not be worried about networks.   Medicare Advantage Plans don’t even have a network of choices that you can be assured will take your coverage.  Please use this BLOG to educate yourself on the different types of coverage BEFORE you sign up.

AS ALWAYS, OUR SENIOR CONSULTANTS ARE HERE TO HELP EXPLAIN THESE ISSUES AND ANSWER YOUR QUESTIONS MORE CLEARLY.

YOU CAN EMAIL US OR CALL US TOLL FREE. 866-752-1795 BE SURE TO TELL US YOU ARE TURNING 65 OR LOSING YOUR COVERAGE.

While you are visiting this BLOG, please scroll on down and read my DRUG SAVINGS NEWSLETTER and also the TOP TEN LIST OF THINGS WRONG WITH MEDICARE.  This will revial more insight into the program and give you more information to ask questions.  Have you ever felt like you didn’t know enough about a topic to know what questions to ask?? We understand how you feel and when we talk to you can shed enough light that you will come up with the questions you need to know to make the BEST DECISIONS ABOUT YOUR MEDICARE COVERAGE.

Please write to me, Karyn Blake, here at My Part D USA’s blog at kblake@MyPartDusa.org. Or you can email this article to a friend.

Published by mypartdusa on May 20, 2009 in Traditional Medicare Supplements.

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www.Top10ThingsWrongWithMedicare.org – PLEASE GO VISIT THIS WEBSITE AND SIGN THE PETITION TO REFORM MEDICARE SO WE ALL CAN HAVE BETTER BENEFITS!

First, I would like to THANK the over 800 of you that have already gone to the site and signed the petition to FIX MEDICARE! Many of you also left comments that are invaluable to getting something done about reforming Medicare benefits.  We would also appreciate any of you sending this to all your friends and people you know that could help us as well.  If you know someone who could get this published or someone who could draw attention to this website, please write to me kblake@mypartdusa.org.

This webiste was donated by a website company, MEDIUM.  It is completely not for profit!  Even the doctors who gave us Testimonies did so at no charge.  This petition will be sent to every government official and newspaper editors, but it is hard to get it to the right person.  If any of you know a better way, please let me know!

IT IS SO VERY EASY TO COMPLAIN!

I WANTED TO ACTUALLY TRY TO DO SOMETHING!  I get emails and phone calls everyday from people trying to get their medications covered and have all kinds of other issues, sometimes I can help them, but many times my hands are tied by the drug and insurance companies.

If I can’t help you, I usually tell you to call Medicare directly.  Sometimes you may have to call several times until you get a person that is willing to help you.  Also you can contact the www.MedicareRights.org or call them at 800-333-4114.  They have free lawyers and counselors that can help you.

If you belong to a Union or group, you could send this website address out to all of them to get more signatures.  THE MORE PEOPLE SEE IT AND SIGN IT, THE MORE ATTENTION WE CAN GET FROM THIS EFFORT!

I DO BELIEVE THAT EVERY VOICE COUNTS! THANK YOU FOR YOURS!

Please write to me, Karyn Blake, here at My Part D USA’s blog at kblake@MyPartDusa.org. Or you can email this article to a friend.

Published by mypartdusa on May 19, 2009 in Where do I go for HELP with Part D or Medicare Issues?.

Start your free comparison now!